Socioeconomic inequalities in causes of death related to behavioural risk-taking in England and Wales: A longitudinal small-area ecological study

OBJECTIVES: We examined socioeconomic trends in behavioural risk-taking deaths (BRDs) before and after the 2008-09 recession at the small area level. STUDY DESIGN: Longitudinal ecological study METHODS: We analysed death registration data for behavioural risk-taking causes (suicide, drug-related, alcohol-related, accidental, and tobacco-related) in England and Wales from 2001 to 2021 at the small areas (population 5,000-8,000) level, aggregated into area deprivation quintiles. Age and sex standardised mortality rates were calculated using annual population estimates. We used a multilevel random-slopes negative binomial segmented regression with interruptions in 2009 and 2011 to estimate the association between mortality rates and the recession. RESULTS: There were over 6.5 million BRDs between 2001 and 2021 (92.4% tobacco-related). Mortality rates were higher among men, in more deprived areas, and in northern regions. The pre-recession declines in tobacco-related mortality slowed after 2011, especially outside London and in more deprived areas. For non-tobacco-related BRDs, mortality rates increased in the post-recession period, but patterns varied by cause and place, with the greatest increases for accidental and drug-related deaths and in deprived areas outside London. Had pre-recession trends continued, there would have been 247,093 (95% CI: 239,942-254,243) fewer tobacco-related deaths and 12,585 (95% CI: 10,510-14,661) fewer non-tobacco-related BRDs between 2011 and 2021. CONCLUSIONS: Socioeconomic inequalities in behavioural risk-taking deaths in England and Wales were stable prior to the 2008-09 recession but widened after 2011 for specific causes, especially outside London.