COVID-19 and health inequalities in Northern Ireland

This article explains data published by the Department of Health as well as the Northern Ireland Statistics and Research Agency, about COVID-19 related health inequalities in Northern Ireland.

[This article is part of the COVID-19 Information Dissemination (COVID-19 ID) Project — a partnership between Community Development and Health Network (CDHN) and FactCheckNI. Its aim is to improve people’s health literacy about COVID-19 by providing accurate and up-to-date information that will increase knowledge, understanding and confidence and enable people to make good health decisions.]

On 17 June 2020, the Department of Health (DoH) in Northern Ireland published a document, Coronavirus related health inequalities in Northern Ireland.

It analysed infection rates and hospital admission rates for COVID-19. A number of factors were explored:

    • socio-economic deprivation;
    • age;
    • gender; and
    • whether people lived in rural, urban or mixed rural/urban areas.

The report did not contain data about people from black and minority ethnic (BME) backgrounds. It also did not include information about co-morbidities. Data was collected up to 9am on 26 May 2020.

It discusses “standardised” rates – infection, admission and mortality – throughout. In practice, standardisation makes adjustments to compensate for differences in population structure (such as age), so valid comparisons can be made between geographical areas.

Infection rates: age, gender and geography

The data for infection rates includes only those with a laboratory completed test that was positive for COVID-19. If people took multiple tests, only the first test was counted. The report points out that laboratory tests have only been carried out for a small proportion of the population in Northern Ireland, including frontline workers, and that this may impact the results.

The age-standardised infection rate in Northern Ireland was 272 people per 100,000 population.

Age was the most important factor in infection rates. The infection rate for over 65s (598 cases per 100,000) was over three times higher as for those 65 and under (192 cases per 100,000).

Where people lived was a significant factor. The infection rate in urban areas (322 per 100,000) was nearly twice as high as people in rural areas (169 per 100,000), with an even higher rate for mixed rural/urban areas (398 per 100,000).

Infection rates for females (308 per 100,000) were a third higher than males (234 per 100,000).

Infection rates: Socio-economic deprivation

Social and economic disadvantage in Northern Ireland is measured by a Multiple Deprivation Measure. This divides Northern Ireland up into small areas and assesses each area against seven criteria — income, employment, health and disability, education and skills, access to services, living environment, crime and disorder.

The DoH report divides deprivation into percentiles. It focuses on the 10% most deprived areas and the 10% least deprived areas. It compares these to the Northern Ireland average. For ease of understanding, this article will refer to the 10% most deprived areas simply as the ‘most deprived areas’ and the 10% least deprived areas as the ‘least deprived areas’.

The infection rate in the most deprived areas in Northern Ireland (379 cases per 100,000) was nearly 40% higher than the Northern Ireland average rate (272 per 100,000).

Those in the least deprived areas also had a higher infection rate (317 per 100,000) than average.

There was a strong link between deprivation, older age and infection rates. The infection rate of people over 65 who lived in the most deprived areas (1,027 per 100,000) was almost three quarters higher than the Northern Ireland average infection rate for over 65s (598 per 100,000).

The least deprived areas had the second highest infection rate for over 65s (750 per 100,000).

The report notes that both the most and least deprived areas are predominantly urban, and that this may be a factor in their higher infection rates.

Hospital admissions for confirmed cases

27% of people who tested positive for COVID-19 were admitted to hospital.

Males who tested positive were twice as likely (39%) to be admitted to hospital as females (19%).

30% of people who tested positive in the most deprived areas were admitted to hospital, compared to 22% of those in the least deprived areas.

Age was by far the largest predictor of hospitalisation for those with positive tests. 69% of those aged 65 and over who tested positive for COVID-19 were admitted to hospital. This compares to 4% of those aged 0-24, and 16% of those aged 25-64.

People who tested positive living in urban areas were slightly more likely to be admitted to hospital (26%) than people living in rural (21%) and mixed rural/urban (22%) areas.

Hospital admissions for confirmed and suspected cases

The above hospital admission data is based on those who had a confirmed laboratory test for COVID-19. However, the DoH report also gives a breakdown for all hospital admissions, including those admitted for confirmed or suspected COVID-19. The following findings are for confirmed and suspected cases.

The hospital admission rate in Northern Ireland was 429 admissions per 100,000 population.

The admission rate for mixed rural/urban areas (750 per 100,000) was more than twice that of rural areas (336 per 100,000). The rate for urban areas (460 per 100,000) was just above the Northern Ireland average.

The admission rate of people living in the most deprived areas (581 per 100,000) was almost double the rate of people living in the least deprived areas (317 per 100,000), which was well below the Northern Ireland average (429 per 100,000).

The admission rate for people 75 and over (2,255 per 100,000) was nine times that of the under 75 population (249 admissions per 100,000).

Age was by far the strongest predictor of hospitalisation.

However, deprivation exacerbated the effect of age.

The rate of hospital admission of people aged 75 and over who lived in the most deprived areas (2,728 admissions per 100,000) was just over a third higher than that for the 75 and over population living in the least deprived areas (2,002 per 100,000).

While the under 75s were much less likely to be admitted to hospital overall, the impact of deprivation is stronger for this group. The admission rate for people under 75 in the most deprived areas (369 per 100,000) was more than double than the least deprived areas (150 per 100,000).

Deprivation and death rates from COVID-19

On 17 June 2020, the Northern Ireland Statistics and Research Agency (NISRA) published data on recorded COVID-19 related deaths in Northern Ireland between 1 March – 31 May 2020. This includes those who had COVID-19 mentioned on their death certificates between these dates.

NISRA compares the 20% most deprived areas with the 20% least deprived areas.

People in the 20% most deprived areas had the highest mortality rate, at 60.5 deaths per 100,000 population. In comparison, people in the 20% least deprived areas had a mortality rate of 49.1 deaths per 100,000, which was just marginally above average.

You can read FactCheckNI’s detailed dive into the data in these reports here.

Further analysis of inequality and COVID-19 and inequality is underway at NISRA. We will update this article when this data becomes available.