Observational studyThe Lancet. Public health2020
Premature mortality attributable to socioeconomic inequality in England between 2003 and 2018: an observational study.
Observational study in The Lancet. Public health, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 107 papers, 3 of them syntheses that pooled it.
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Who cites it
107 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- COVID-19's disruptions to cancer care pathways and widening of health inequalities in the UK: a systematic review.BMC health services research · 2026Pooled it
- Does socioeconomic position moderate the associations between the content and delivery features of digital behaviour change interventions for smoking cessation and intervention effectiveness? A systematic review and meta-analysis.Health psychology review · 2024Pooled it
- Seroprevalence of hepatitis E virus infection in the Americas: Estimates from a systematic review and meta-analysis.PloS one · 2022Pooled it
- Prevalence of loneliness and its associated factors in middle-aged and older adults with breathlessness: a nationally representative cohort study.BMJ open respiratory research · 2026Article
- Conjoint association of gestational diabetes mellitus and hypertensive disorders of pregnancy with long-term risk of mortality: a population-based cohort study.Journal of global health · 2026Article
- Examining Racial Discrimination Index and Black-Years of Potential Life Lost (YPLL) in South Carolina: A Real-Time Social Media Research.Journal of racial and ethnic health disparities · 2026Article
- Social inequalities in cause-specific premature mortality in rural and urban France: a pre-pandemic population attributable fraction analysis.Population health metrics · 2026Article
- Revisiting the social determinants of health with explainable AI: a cross-country perspective.American journal of epidemiology · 2026Article
- For reducing premature adult mortality in India, education matters more than income.Proceedings of the National Academy of Sciences of the United States of America · 2026Article
- Article
- Association of comorbidities and socioeconomic deprivation among people who died from dementia in England between 2013 and 2023: analysis of death certificates.Age and ageing · 2026Article
- Measuring health inequalities in liver transplantation: a systematic review of deprivation scores for survival in end-stage liver disease.BMJ public health · 2026Article
- Trends in recorded deaths involving antipsychotics: The role of deprivation, ethnicity, and regional disparities.PloS one · 2026Article
- Individual- and area-level socioeconomic inequalities in cancer incidence in the working-age population - a cohort study based on German statutory health insurance data, 2015 to 2019.BMC public health · 2025Article
- Years of potential life lost due to drug-susceptible pulmonary tuberculosis in Cali, Colombia, 2009-2020.Revista peruana de medicina experimental y salud publica · 2025Article
- The crucial role of early diagnosis for patients and the nation, understanding the costs of late-stage cancer diagnosis from a large district general hospital in England.Cost effectiveness and resource allocation : C/E · 2025Article
- Spatial variation in cause-specific premature mortality and its association with socioeconomic deprivation in Belgium from 2000 to 2019.Archives of public health = Archives belges de sante publique · 2025Article
- Relationship between biological ageing, premature mortality, life expectancy, and number of live births: a prospective cohort study of the UK women.BMC public health · 2025Article
- Global socioeconomic inequalities in breast, cervical, ovarian, and uterine cancers incidence, mortality, disability-adjusted life year's rates: a relative concentration index analysis.BMC women's health · 2025Article
- All-cause and cause-specific mortality attributable to educational inequalities in Spain.BMC public health · 2025Article
47 more citing papers are in PubMed but not listed here.
Corrections and comments
- Commented on by
- Erratum issued
Authors and funding
7 authors.
Funding
Abstract
backgroundLow socioeconomic position is consistently associated with increased risk of premature death. The aim of this study is to measure the aggregate scale of inequality in premature mortality for the whole population of England.
methodsWe used mortality records from the UK Office for National Statistics to study all 2 465 285 premature deaths (defined as those before age 75 years) in England between Jan 1, 2003, and Dec 31, 2018. Socioeconomic position was defined using deciles of the Index of Multiple Deprivation: a measure of neighbourhood income, employment, education levels, crime, health, availability of services, and local environment. We calculated the number of expected deaths by applying mortality in the least deprived decile to other deciles, within the strata of age, sex, and time. The mortality attributable to socioeconomic inequality was defined as the difference between the observed and expected deaths. We also used life table modelling to estimate years-of-life lost attributable to socioeconomic inequality.
findings35·6% (95% CI 35·3-35·9) of premature deaths were attributable to socioeconomic inequality, equating to 877 082 deaths, or one every 10 min. The biggest contributors were ischaemic heart disease (152 171 excess deaths), respiratory cancers (111 083) and chronic obstructive pulmonary disease (83 593). The most unequal causes of death were tuberculosis, opioid use, HIV, psychoactive drugs use, viral hepatitis, and obesity, each with more than two-thirds attributable to inequality. Inequality was greater among men and peaked in early childhood and at age 40-49 years. The proportion of deaths attributable to inequality increased during the study period, particularly for women, because mortality rates among the most deprived women (excluding cardiovascular diseases) plateaued, and for some diseases increased. A mean of 14·4 months of life before age 75 years are lost due to socioeconomic inequality.
interpretationOne in three premature deaths are attributable to socioeconomic inequality, making this our most important public health challenge. Interventions that address upstream determinants of health should be prioritised.
fundingNational Institute of Health Research; Wellcome Trust.
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