6595 Child mortality in England during, and after, the COVID-19 pandemic

Objectives During the COVID-19 pandemic CYP mortality in England reduced to the lowest on record,¹ 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, across the whole of England, before, during, and after the COVID pandemic and its social changes. Methods Deaths of children occurring from April 2019 until March 2023 were identified and divided into four 12-month periods (April to March). The underlying population profile was obtained from 2021 ONS Census data. Mortality rate for each analysis year was calculated per 1,000,000 person years. A Poisson regression model was used to test for an overall trend across the time period, and tested if trends were different before and after 31st March 2021 (the spring after the COVID pandemic's peak). This was then repeated for each demographic group. Results Overall, mortality rate dropped from 291.8 (282.1–301.7) in 2019–20 to 260.8 (251.7–270.2) in 2020–21, then rose to 294.8 (285.1–304.8) in 2021–22, and then 319.8 (309.6–330.1) in 2022–23 (p<0.001). There was good evidence that deaths reduced initially (RR 0.96 (0.93–0.99)) and then increased after (RR 1.12 (1.09–1.16)) (p<0.001) (figure 1). Repeating the analysis, split by child characteristics, suggested that patterns of mortality were not modified by sex, area of residence, or region of England. However, the profile did differ by age, with mortality dropping and then rising for children under 16 years, but showing continuous increases for children in the oldest age group (RR 1.08 (1.02–1.14)). Asian, Black, and Other ethnic groups, and those in more deprived areas, had evidence of a reduction in mortality across the first period, and then an increase in the second. There was little evidence that mortality for children from White or Mixed ethnic backgrounds, or those in the least deprived areas, changed over the study period. Relative Risks are per year with 95% confidence intervals. Risk per month as Gaussian smoothed over 5 month period. Trends shown as smoothed cubic spline. Conclusion Any mortality gains, often to vulnerable children, seen during the wide-ranging social changes put in place to reduce the spread and impact of COVID-19 have now dissipated, and overall child mortality in 2022–23 in England is now higher than before the pandemic. The high risk ethnic groups, appeared to have had the most benefit from the reduction in child mortality seen across 2021–22, but these groups also appear to have experienced a disproportional increase in mortality in the last 2 years. Reference Odd D, Stoianova S, Williams T, Fleming P, Luyt K. Child mortality in England during the first 2 years of the COVID-19 pandemic. JAMA Netw Open 2023;6(1):e2249191.