Covid-19: The equaliser or divider?
Middle-income to affluent and even wealthy groups have shown big increases in mortality in the coronavirus era
Covid-19 has been characterised as a “great equaliser” that transcends wealth, fame, prestige or age. Others have emphasised the vulnerability of disadvantaged groups, whether from the point of view of economic impact or lack of access to health care.
We take a data-driven approach to the topic and have previously shown how Covid-19 had a disproportionately negative effect on both the lowest and highest income groups. As both groups are largely self-employed, they are more directly exposed to the economy without the relative safety of earning a salary. Our recent data indicates that the economic impact of (Covid-19-induced) lockdowns has washed through the system and incomes across segments are largely back to pre-Covid-19 levels.
With economic recovery well under way, albeit to still rather pedestrian long-term growth levels, the focus is on vaccinating the population while managing the impact of the third and any other potential waves, triggered by mutations of the virus and evolving behaviour. In this context it is useful to analyse how severely Covid-19 has affected different population groupings.
Our data reflects an analysis, performed on a non-identifiable basis, of more than 8-million individuals banking with us, comparing pre-Covid-19 mortality with rates during peak months. We didn’t measure actual Covid-19 deaths, just the actual level of, and change in, mortality during the different periods.
Our first analysis focused on age, which is widely accepted to be the dominant driver of mortality. It found that the increase in mortality was confined to those above the age of 40, with the largest absolute increase in mortality from 60-80 and the highest relative increase from 50-70 (70%-80% relative increase).
This matches international experience, confirming age as the main driver of mortality (note we don’t measure comorbidity, but it often correlates with age). Our data shows mortality of those below 30 years of age decreased, with Covid-19 related deaths more than matched by a decrease in other causes of death.
This data strongly supports the government’s plan to use age as prioritisation criteria for the vaccine rollout programme. It also indicates a level of risk in the working population for above 50-year-olds and to a lesser extent above 40-year-olds, making prioritisation of rollout to these groups critical to move towards normalising working environments and limiting impact to our economy.
Mortality by gender shows an equal picture, with a slightly higher absolute increase in males but slightly higher relative increase in females, with both genders at almost similar (increase in) risk.
An interesting view is obtained by analysing provincial data — as we’ve seen, the spread of Covid-19 is affected by geographical population concentrations and travel patterns, having peaked first in the Western Cape before moving into the rest of the country. The Eastern Cape (double its mortality rate) and KwaZulu-Natal (70% increase) are the outliers, but the management of the epidemic and of health-care services at local level has an impact on outcomes.
Our final analysis — mortality outcomes by income segment — is perhaps the most interesting and unexpected of all. It is instructive to compare the large difference in mortality for the pre-Covid-19 period, which shows significantly lower mortality for high-income earners (above R450,000 per annum) than for low-middle earners (below R450,000). This is undoubtedly a function of access to quality health care, and possibly general lifestyle choices. Our data shows a big equalising impact from Covid-19, with middle to affluent and even wealthy groups showing big increases in mortality (doubling or even tripling).
In conclusion, our data shows the mortality impact of Covid-19 has largely been on the elderly and middle aged, has affected some provinces more than others, and has not spared any income groups, with a disproportionate impact on middle to upper income earners who normally have much better mortality outcomes. The data strongly supports the government’s age-based vaccine rollout plan and shows the importance of provincial epidemic and health-care management, as well as the importance of taking precautions even if — perhaps especially —if you have money.
• Dr Nieuwoudt is FNB chief data & analytics officer.
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