Socioeconomic inequalities in avoidable mortality in Wales: 2020

More commentary on socioeconomic inequalities in avoidable mortality is available on the following page:

• Socioeconomic inequalities in avoidable mortality in England: 2020

• Avoidable deaths accounted for 37.0% of all male deaths in the most deprived areas of Wales compared with 18.9% in the least deprived areas in 2020; for females it was 25.7% and 14.1% respectively.

• While avoidable mortality rates have decreased in 2020 compared with 2001, they have increased compared with 2019.

• Avoidable mortality rates with coronavirus (COVID-19) as an underlying cause of death were statistically significantly higher in the most deprived areas compared with the least deprived areas.

• The Slope Index of Inequality (SII) indicated that there were 460.9 additional deaths per 100,000 males and 279.1 additional deaths per 100,000 females living in the most deprived areas compared with the least deprived areas in 2020.

Statistician’s comment

"Today’s data show there were increases in avoidable mortality rates in Wales in 2020. The figures point to an increased level of inequality, as the gap in avoidable mortality between the most and least deprived areas widened to the highest level since 2003 for males and since the data began in 2001 for females. Future analysis will show how this gap changes as we emerge from the pandemic."

Chris White, Head of Health Inequalities, at the Office for National Statistics.

In 2020, the male avoidable age-standardised mortality rate (ASMR) in the most deprived areas of Wales (quintile 1) was 581.6 deaths per 100,000 males; statistically significantly higher than the 205.6 deaths per 100,000 males observed in the least deprived areas (quintile 5).

The female avoidable ASMR also showed a statistically significant contrast with 381.0 deaths per 100,000 females in the most deprived areas compared with 146.1 deaths per 100,000 females in the least deprived areas (Figure 1). Mortality rates for males were statistically significantly higher than females across all deprivation quintiles.

Avoidable mortality rates between 2001 and 2020 have statistically significantly decreased for males living in the most deprived areas, and males and females in the least deprived areas. Most recently, between 2019 and 2020, avoidable ASMRs have increased for males and females living in both the most and least deprived areas of Wales. However, these increases were only statistically significant for females living in the most deprived areas. The absolute gap in avoidable mortality between the most and least deprived areas has widened to the highest level since 2003 for males and since the data time series began for females.

In this section we are focusing on:

• COVID-19 as a new cause in the avoidable mortality definition

• neoplasms (cancers) and diseases of the circulatory system because they are the largest causes of avoidable mortality for females and males respectively

Provisional assignment of new diseases

Provisional assignment of new diseases is a new category in the Organisation for Economic Co-operation and Development's (OECD's) international avoidable mortality definition (PDF, 694KB) to accommodate coronavirus (COVID-19) as an avoidable cause of death. There are no other causes of death within the category.

In 2020, the avoidable mortality rates for deaths due to COVID-19 were statistically significantly higher for those in the most deprived areas compared with the least deprived areas (Figure 2). The age-standardised mortality rates (ASMR) in the most deprived areas were 91.3 deaths per 100,000 males and 53.6 deaths per 100,000 females, compared with 32.7 deaths per 100,000 males and 14.9 deaths per 100,000 females in the least deprived areas.

There are complex factors to consider when trying to understand the reasons why COVID-19 deaths are higher in the most deprived areas compared with the least deprived areas. For further information on COVID-19 data and their impact on society and the economy, please see the COVID-19 interactive dashboard, produced by the Welsh Government.

Neoplasms (cancers)

Between 2001 and 2020, ASMRs for neoplasms have fluctuated, with overall non-significant decreases for males and females living in the most deprived areas and females in the least deprived areas (Figure 3). For males in the least deprived areas of Wales, there has been a statistically significant decrease in the avoidable ASMR for neoplasms between 2001 and 2020, falling from 98.6 to 60.6 deaths per 100,000 males.

For males, the absolute gap in avoidable mortality between the most and least deprived areas of Wales widened between 2019 and 2020, with a gap of 66.2 deaths per 100,000 males in 2019 compared with a gap of 73.8 deaths per 100,000 males in 2020. Conversely, the female absolute gap narrowed from 55.3 deaths per 100,000 females in 2019 to 50.7 deaths per 100,000 females in 2020.

In 2020, ASMRs for neoplasms in the most deprived areas were statistically significantly higher than those in the least deprived areas of Wales, for both males and females. This supports findings from Public Health Wales who report increased death rates from all cancers as area deprivation increases.

Diseases of the circulatory system

Between 2001 and 2020, the ASMRs for diseases of the circulatory system have statistically significantly decreased for males and females living in the most and least deprived areas of Wales (Figure 4). However, the largest improvements were mainly seen in the first decade, with statistically significant decreases between 2001 and 2010. In the second decade, improvements have slowed, with non-significant decreases between 2011 and 2020.

For males, the absolute gap in avoidable mortality between the most and least deprived areas widened to 113.2 deaths per 100,000 males in 2020, compared with 108.8 deaths per 100,000 males in 2019. Similarly, the absolute gap also widened for females, with a gap of 57.3 deaths per 100,000 females in 2020 compared with 48.2 deaths per 100,000 females in 2019.

The SII measures the absolute inequality and represents the difference between the hypothetical "most" and "least" deprived areas on the deprivation scale. In this release, the SII figure represents the number of additional avoidable deaths per 100,000 people in the most deprived areas compared with the least.

Between 2001 and 2020, the inequality in the avoidable mortality rate non-statistically significantly increased from 425.8 to 460.9 deaths per 100,000 males and 263.2 to 279.1 deaths per 100,000 females (Figure 5).

Across the data time series, the SII has fluctuated. Since 2013, which saw the lowest inequality between those in the most and least deprived areas, the SII has statistically significantly increased for both males and females. Inequality in avoidable mortality remained statistically significantly higher for males compared with females across the data time series.

Preventable mortality

Refers to causes of death that can be mainly avoided through effective public health and primary prevention interventions (that is, before the onset of diseases or injuries, to reduce incidence).

Treatable mortality

Refers to causes of death that can be mainly avoided through timely and effective health care interventions, including secondary prevention and treatment (that is, after the onset of disease, to reduce case-fatality).

Avoidable mortality

Refers to deaths that are preventable or treatable.

Age-standardised mortality rates

Used to allow comparisons between populations that may contain different proportions of people of different ages.

Statistical significance

Refers to statistically significant changes or differences. Statistical significance has been determined using the 95% confidence intervals, where instances of non-overlapping confidence intervals between figures indicate the difference is unlikely to have arisen from random fluctuation.

Further explanation can be found on our uncertainty page.

Slope Index of Inequality (SII)

Models the absolute inequality (the difference between the hypothetical most and least deprived populations) in avoidable mortality using weighted linear regression. This takes account of the inequality across all adjacent quintiles of relative deprivation, rather than focusing only on the differencing of the two extremes.

Figures are calculated using death registration data for Wales held by the Office for National Statistics (ONS).

Defining avoidable mortality

The Organisation for Economic Co-operation and Development's (OECD's) international avoidable mortality definition (PDF, 694KB), has been implemented from 2001 onwards.

More quality and methodology information on strengths, limitations, appropriate uses, and how the data were created is available in the Socioeconomic inequalities in avoidable mortality QMI. Further breakdowns of data are available in our Socioeconomic inequalities in avoidable mortality: Wales datasets. 

Socioeconomic deprivation

Socioeconomic deprivation is measured using the Welsh Index of Multiple Deprivation (WIMD), which provides an overall relative measure of deprivation for each Lower-layer Super Output Area (LSOA). More information can be found in the Socioeconomic inequalities in avoidable mortality QMI.

Early access for quality assurance purposes

We provide early access for quality assurance to a small number of people working in other government bodies. This is for general comment on the plausibility of our findings. However, the Office for National Statistics (ONS) independently produces these statistics, including determining the content and interpretation of these measures presented in bulletins.

The main strength of the socioeconomic inequalities in avoidable mortality bulletin is that the implementation of the new avoidable mortality definition (PDF, 695KB) means our statistics are internationally comparable.

The main limitation of the socioeconomic inequalities in avoidable mortality bulletin is that cause of death data do not account for coding changes that occurred in 2011 and 2014.