Deaths of despair in England, 2014–2022: trends by sex and socioeconomic deprivation before and after COVID-19

Objectives: Deaths of despair-alcohol, substance use, suicide and non-organic mental health related-have attracted international attention, but English evidence remains limited. We examined trends in deaths of despair in England (2014-2022), including COVID-19 impacts and inequalities by sex and deprivation. Methods: We analysed all registered deaths in England (2014-2022), identifying deaths of despair by ICD-10 code. Age-standardised mortality rates, years of life lost, and inequalities by sex and deprivation were calculated. Log-linear regression estimated pre-pandemic trends and deviations during COVID-19. Results: There were 133,600 deaths of despair (2.9% of all deaths). Age-standardised mortality rates rose 33%, from 22.6 to 30.1 per 100,000. Mortality was consistently higher in men and deprived areas, with widening inequalities. During COVID-19, mortality temporarily exceeded the pre-pandemic trend, particularly among women and deprived groups, before returning to trend. Deaths of despair accounted for a rising share of years of potential life lost (13.9%-16.6%). Conclusion: Deaths of despair increased substantially in England, contributing a growing burden of premature mortality. Persistent, widening inequalities highlight a public health challenge requiring surveillance and interventions addressing immediate causes and social determinants.