While child mortality rates initially dropped during COVID-19 lockdowns, a new study reveals a concerning rise post-lockdown, with disparities widening for non-white children and those in deprived areas.

Study: Child mortality in England after national lockdowns for COVID-19: An analysis of childhood deaths, 2019–2023. Image Credit: Gabriel Pahontu/Shutterstock.com

In a recent study published in PLOS Medicine, researchers from the United Kingdom (U.K.) investigated the trends and causes of childhood deaths in England from 2019 to 2023, focusing on changes before, during, and after the coronavirus disease 2019 (COVID-19) lockdowns.

The study aimed to determine whether the mortality reductions observed during the pandemic persisted after the lockdowns and examined variations across demographics and socioeconomic conditions.

Background

Child mortality worldwide has been shaped by various health interventions, public policies, and socio-environmental factors. During the COVID-19 pandemic, child mortality in England dropped to historic lows, which was attributed to factors such as reduced infections and enhanced public health practices during lockdowns that included school closures and restricted movement.

However, the long-term impacts of the pandemic and its subsequent social disruptions remain unclear. Certain deaths, such as those related to delayed treatment for chronic conditions, may exhibit delayed patterns due to restricted healthcare access during lockdowns.

Additionally, evidence suggests that while mortality rates decreased overall, disparities persisted across socioeconomic and ethnic groups, raising questions about health inequalities.

The current study

In the present study, the researchers examined all childhood deaths among age groups ranging from newborns to 17 years in England between April 2019 and March 2023 using data from the National Child Mortality Database. The population data was derived from the 2021 census, covering various demographics, including age, sex, ethnicity, and socioeconomic status.

The researchers categorized deaths by primary causes, such as preterm birth, trauma, infections, and underlying medical conditions, through a standardized coding process by independent pediatricians.

Additionally, the mortality rates were calculated annually per 1,000,000 person-years, and temporal trends were analyzed using regression models.

The study defined two periods: April 2019 to March 2021, which encompassed the lockdowns, and between April 2021 and March 2023, which was the post-lockdown period. Statistical models were applied to detect the changes in death rate trajectories between these periods.

The analysis also assessed the relative mortality risks based on socioeconomic deprivation and ethnicity by comparing death rates across population deciles and ethnic groups.

The researchers also performed sensitivity analyses stratification by age groups and exclusion of deaths from extreme preterm births at less than 23 weeks. Additional modeling analyses identified excess deaths from 2022 to 2023 and compared them to pre-pandemic levels.

The study focused on understanding both direct and indirect pandemic effects, including public health behaviors and healthcare disruptions, while addressing health inequalities.

Major findings

The researchers observed that child mortality in England initially decreased during the COVID-19 lockdowns but rose significantly after the restrictions were lifted, even surpassing pre-pandemic levels.

Mortality declined across most demographic groups in the 2020 to 2021 period, with infections and deaths from underlying diseases showing the most pronounced reductions. However, by 2022–2023, the mortality rates increased across almost all categories.

Infections showed a significant rebound, with rates rising beyond pre-lockdown levels, particularly among children under one year of age.

Similarly, deaths from trauma, preterm births, and sudden unexpected deaths in infancy and childhood increased steadily across the study period. However, deaths from malignancy remained stable, indicating no discernible impact from the pandemic. In contrast, intrapartum-related deaths rose during the lockdowns but subsequently declined post-pandemic.

The study revealed major disparities, with mortality rates among children from non-white ethnic backgrounds and socioeconomically deprived areas showing marked increases post-lockdowns.

While deaths in these groups did not drop during the pandemic, they demonstrated significant surges after the pandemic-associated restrictions were lifted, widening pre-existing health inequalities. This was particularly evident in trauma-related and infection-related deaths.

Furthermore, age-stratified analysis revealed that the mortality trends varied significantly. Children between the ages of 1 and 4 years experienced the most pronounced shift, with rates declining during lockdowns but surging afterward.

Older adolescents of about 16 or 17 years showed a steady increase in mortality throughout the study period. Geographic differences were also noted by the researchers, with urban areas, especially London, reporting higher death rates.

Conclusions

Overall, the findings highlighted the complex, lasting effects of the COVID-19 pandemic on child mortality in England. While initial reductions were observed during the pandemic-related lockdowns, mortality rates increased post-pandemic, particularly among disadvantaged groups.

Furthermore, increasing deaths from infections, trauma, and preterm births highlighted the ongoing challenges in pediatric health. The study indicated that addressing these disparities and mitigating indirect pandemic effects require strengthened public health measures and focused interventions for vulnerable children to ensure equitable outcomes in future health crises.