COVID-19 Health Inequalities Monitoring for England (CHIME) tool
The CHIME tool brings together data relating to the direct impacts of COVID-19, such as for mortality rates, hospital admissions and confirmed cases.
By presenting inequality breakdowns, including by age, sex, ethnic group, level of deprivation and region, the tool provides a single point of access in order to:
- show how inequalities have changed during the course of the pandemic and what the current cumulative picture is
- bring together data in one tool to enable users to access and utilise the intelligence more easily
- provide indicators with a consistent methodology across different datasets to facilitate understanding
- support users to identify and address inequalities within their areas and identify priority areas for recovery
Within the latest release (24/06/2021), the following indicators are presented:
Confirmed cases (new to CHIME)
Cases of COVID-19 confirmed by having at least one positive test result
- Monthly confirmed case rates
- Cumulative confirmed case rates
- Number of confirmed COVID-19 cases
Hospital admissions (updated to include February 2021 admissions)
Admissions where COVID-19 was the primary reason for the patient being taken into hospital
- Monthly admission rates
- Cumulative admission rates
- Number of hospital admissions
Deaths (updated to include April 2021 deaths)
Deaths involving COVID-19, where it was mentioned anywhere on the death certificate
- Monthly death rates
- Cumulative death rates
- Number of deaths
For each of these indicators, data are split into the following:
- England (persons only indicator)
- Age - England
- Age - Region
- Deprivation deciles - England
- Deprivation deciles - England - Under 75s
- Deprivation deciles - Region
- Deprivation deciles - Region - Under 75s
- Ethnic groups - England
- Ethnic groups (detailed Asian) - England
- Ethnic groups (detailed Black) - England
- Ethnic groups - Region (not available for monthly indicators)
The work supplements the 'Disparities in the risk and outcomes of COVID-19' report, published in June 2020.
We are interested in your feedback on the tool. If you have any comments or suggested changes, please contact us.
The COVID-19 Health Inequalities Monitoring for England (CHIME) tool currently includes data on hospital admissions and mortality from COVID-19, and confirmed cases of COVID-19. It presents the cumulative picture for the pandemic to date and data by month, and includes breakdowns by region, sex, age group, ethnicity and deprivation.
The following indicators are included:
- Cumulative age-standardised hospital admission rate per 100,000 population where COVID-19 was the primary reason for admission between March 2020 and February 2021
- Monthly age-standardised hospital admission rates per 100,000 person-years
- Cumulative age-standardised mortality rates per 100,000 population for deaths involving COVID-19 between March 2020 and April 2021
- Monthly age-standardised hospital admission rates per 100,000 person-years
- Cumulative age-standardised confirmed COVID-19 case rates per 100,000 population between March 2020 and May 2021
- Monthly age-standardised confirmed COVID-19 case rates per 100,000 person-years
Trends over time
There were two peaks in monthly mortality and hospital admission rates, in April 2020 and January 2021, during the first and second waves of the pandemic. For England as a whole, the monthly mortality and hospital admission rates at the peak of the second wave were higher than the first wave.
The trend for confirmed case rates is different as these will be influenced by the availability of testing for COVID-19 in the early months of the pandemic. Swab testing for the wider population (as part of the UK government testing programme) did not begin in England until July 2020. In the second wave of the pandemic, confirmed cases peaked in January 2021.
Age and sex
Across the course of the pandemic in England, cumulative hospital admission and mortality rates were higher for males than females. In the pandemic period presented to date, the mortality rate in males was 1.6 times higher than the rate for females and the hospital admission rate was 1.5 times higher.
In contrast, across the course of the pandemic the confirmed case rate to May 2021 was higher for females, but the difference between the sexes was not as great as for deaths and admissions, with the rate for females 1.1 times that for males.
Hospital admission and mortality rates increased with age, with the highest rates in those aged 85 and over. The mortality rate for people in this age group across the pandemic to date was 3.2 times higher than the next oldest group (people aged 75-84) and 10.7 times higher than people aged 65-74. This increase in mortality rates with age was steeper than that seen for hospital admissions.
The pattern by age group is not the same for confirmed cases. Although the cumulative rate up to the end of May 2021 was highest for those aged 85 and over, the second highest rate was for those aged 25-49 and the lowest rate was for those aged 65-74. As noted above, the cumulative confirmed case rates will be influenced by the availability of testing in the early months of the pandemic.
Across the pandemic period to date, the impact, in terms of hospital admissions and deaths, has been greatest in London and lowest in the South West. In terms of confirmed cases, the impact has been greatest in the North West, followed by London, and lowest in the South West.
In England as a whole, the monthly mortality and hospital admission rates at the peak of the second wave were higher than the first wave. For admissions this was true for every region of England, although in Yorkshire and the Humber the month with the highest rate was November 2020.
For mortality, the picture varied by region. London and the northern regions had a higher monthly rate at the peak of the first wave than the second, and in the West Midlands the two peaks were similar. All other regions had higher mortality at the peak of the second wave. These are the general patterns and there are some differences by sex.
London had higher mortality and hospital admission rates than every other region in England at the peak of both the first and second waves, and the highest confirmed case rate during the peak of the second wave. However, during November 2020, an increase in hospital admission and mortality rates in the northern and midlands regions meant they were higher than London at this point, and confirmed case rates in these regions were higher than London in both October and November. This reflects the difference in timing of the second wave across England.
Over the course of the pandemic to May 2021, the Asian ethnic group had the highest confirmed case rate, 1.8 times the rate for the White and Mixed groups, which had the lowest rates. The cumulative confirmed case rate for the Black ethnic group was 1.4 times the rate for the White and Mixed groups. Among the Asian groups, the Pakistani and Bangladeshi groups had the highest confirmed case rates.
The highest cumulative admission and mortality rates were in the Black and Asian groups. The hospital admission rate for the Black and Asian groups was three times higher than the rate for the White group. The mortality rate for the Black and Asian group was two times higher than the White group. Among the Black and Asian groups, the Other Black, Bangladeshi and Pakistani groups had the highest mortality and admissions rates.
This pattern in confirmed case rates, mortality and hospital admissions by ethnicity varied considerably across regions of England. The numbers in each group are small in some regions which makes comparison difficult.
In England as a whole, the Black group had the highest monthly mortality rate at the peak of the first wave, whereas the Asian group had the highest monthly rate at the peak of the second wave. This is also true for hospital admissions although the difference at the peak of the second wave is small. Among the Asian group, the Bangladeshi group had a particularly high admission and mortality rate at the peak of the second wave, which was not the case in the first, and may account for this difference between waves.
Inequality in mortality and hospital admissions between the Black and White groups was greater at the peak of the first wave. At the peak of the first wave the admission rate in the Black group was 3.9 times higher than the White group, but was 3.2 times higher at the peak of the second wave. For mortality the rate in the Black group was 2.9 times higher in the peak of the first wave and 2.1 times in the second.
However, inequality in mortality and hospital admissions between the Asian and White groups was greater at the peak of the second wave. The admission rate in the Asian group was 2.8 times higher than the White group at the peak of the first wave and increased to 3.3 times higher. The mortality rate was 2.1 times higher at the peak of the first wave and 2.3 times higher in the second.
There was a gradient in confirmed case rates, hospital admissions and mortality by level of deprivation: the impact of the pandemic to date increased with each increase in level of deprivation. Across the pandemic to date, the cumulative admission rate for the most deprived in England was 2.9 times the rate for the least deprived and the mortality rate over this period was 2.4 times higher. The level of inequality was narrower for confirmed cases, but the rate for the most deprived was still 1.6 times that for the least deprived.
This gradient by deprivation is seen across most regions, but there is some variation in the pattern. For example, in the South West, the cumulative mortality rate and confirmed case rate in the most deprived were both much higher than for all other deprivation groups.
Inequalities in mortality and hospital admissions by deprivation were slightly lower in the peak of the second wave than the first, however in November 2020, there was an increase in mortality and hospital admission rates in the most deprived decile which meant it was much higher than the other deciles at this time point. This increase was also seen in the most deprived decile for confirmed cases in October and November 2020. This pattern was observed in both males and females and coincided with the increase in the northern and midlands regions of England at this time.