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Religious affiliation and COVID-19-related mortality: a retrospective cohort study of prelockdown and postlockdown risks in England and Wales
  1. Charlotte Hannah Gaughan1,
  2. Daniel Ayoubkhani1,
  3. Vahe Nafilyan1,2,
  4. Peter Goldblatt3,
  5. Chris White4,
  6. Karen TIngay1,
  7. Neil Bannister4
  1. 1Methodology, Office for National Statistics, Newport, UK
  2. 2Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
  3. 3UCL Institute of Health Equity, University College London, London, UK
  4. 4Health Analysis, Office for National Statistics, Newport, UK
  1. Correspondence to Charlotte Hannah Gaughan, Methodology, Office for National Statistics, Newport NP10 8XG, UK; charlotte.gaughan{at}


Background COVID-19 mortality risk is associated with demographic and behavioural factors; furthermore, religious gatherings have been linked with the spread of COVID-19. We sought to understand the variation in risk of COVID-19-related death across religious groups in England and Wales both before and after the first national lockdown.

Methods We conducted a retrospective cohort study of usual residents in England and Wales enumerated at the 2011 Census (n=47 873 294, estimated response rate 94%) for risk of death involving COVID-19 using linked death certificates. Cox regression models were estimated to compare risks between religious groups. Time-dependent coefficients were added to the model allowing HRs before and after lockdown period to be estimated separately.

Results Compared with Christians, all religious groups had an elevated risk of death involving COVID-19; the largest age-adjusted HRs were for Muslim and Jewish males at 2.5 (95% CI 2.3 to 2.7) and 2.1 (95% CI 1.9 to 2.5), respectively. The corresponding HRs for Muslim and Jewish females were 1.9 (95% CI 1.7 to 2.1) and 1.5 (95% CI 1.7 to 2.1), respectively. The difference in risk between groups contracted after lockdown. Those who affiliated with no religion had the lowest risk of COVID-19-related death before and after lockdown.

Conclusion The majority of the variation in COVID-19 mortality risk was explained by controlling for sociodemographic and geographic determinants; however, those of Jewish affiliation remained at a higher risk of death compared with all other groups. Lockdown measures were associated with reduced differences in COVID-19 mortality rates between religious groups; further research is required to understand the causal mechanisms.

  • epidemiology
  • socio-economic
  • social inequalities
  • COVID-19

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  • Contributors CHG wrote the first draft of the manuscript. VN, CHG, CW and DA designed the analysis. CHG, DA and VN conducted the statistical modelling. All authors edited and reviewed the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer The employers had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

  • Competing interests The authors (except PG) are employees of the UK Civil Service. PG is an advisor at the University College London Institute of Health Equality.

  • Patient consent for publication Not required.

  • Ethics approval This project was ethically self-assessed against the ethical principles of the National Statistician’s Data Ethics Advisory Committee (NSDEC) using NSDEC’s ethics self-assessment tool.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. The study is based on deidentified census and death certificate data. We cannot provide further breakdowns. Further information on future statistical analysis plans is available upon request.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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