Child Mortality in England after the Pandemic. Increasing Mortality and Inequalities

Background During the COVID-19 pandemic children and young people (CYP) mortality in England reduced to the lowest on record, but it is unclear if the mechanisms which facilitated a reduction in mortality had a longer lasting impact, and what impact the pandemic, and its social restrictions, have had on deaths with longer latencies (e.g. malignancies). The aim of this analysis was to quantify the relative risk of childhood deaths, in England, before, during, and after the COVID pandemic and its social changes. Methods and Findings Mortality for each analysis year was calculated per 1,000,000 person years. Poisson regression was used to test for an overall trend across the time period, and tested if trends differed between April 2019 to March 2021 (Period 1)) and April 2021 to March 2023 (Period 2). This was then repeated for each category of death and demographic group. The underlying population profile was obtained from 2021 ONS Census data. 12,828 deaths were included in the analysis. 59.4% of deaths occurred under 1 year of age. Mortality rate (per 1,000,000 CYP per year) dropped from 272.2 (264.8-283.8) in 2019-20, to 242.2 (233.4-251.2) in 2020-21, increasing to 296.1 (286.3-306.1) in 2022-23. Overall, death rate reduced in Period 1 (RR 0.96 (0.92-0.99)) and then increased in Period 2 (RR 1.12 (1.08-1.16)). Asian (p<0.001), Black (p-0.012), and Other (p=0.003) ethnic groups, and those in more deprived areas (p<0.001), had evidence of an initial reduction mortality, and then a subsequent increase. Death rates for children from White (p=0.601) or Mixed (p=0.823) ethnic backgrounds, or those in the least deprived areas, did not change over the study period. Conclusions Different temporal profiles were seen across cause of death categories, with reassuring trends in deaths from Suicide and Intrapartum deaths (after pandemic peaks). However, for all other causes of death, rates are either static, or increasing. Overall child mortality in England is now higher than before the pandemic. In addition, any reductions in health inequalities seen moving into, and during, the pandemic have now disappeared. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement Yes ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Chair of the Central Bristol NHS Research Ethics Committee I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Not Applicable The data underlying the results presented in the study may be available on request to the corresponding author, and subject to approval by Healthcare Quality Improvement Partnership (HQIP).