COVID-19 Health Inequalities Monitoring for England (CHIME) tool
The CHIME tool brings together data relating to the impacts of COVID-19, for factors such as mortality rates, hospital admissions, confirmed cases, vaccinations and life expectancy.
By presenting inequality breakdowns, including by age, sex, ethnic group, level of deprivation, population density 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 (09/09/2021), the following indicators are presented:
Non-COVID-19 deaths (new to CHIME)
Deaths where COVID-19 was not mentioned anywhere on the death certificate
All cause deaths (new to CHIME)
Deaths from all causes, including COVID-19
Life expectancy (new to CHIME)
Life expectancy at birth and inequality in life expectancy at birth
Life expectancy breakdown (new to CHIME)
Breakdowns showing the contribution of age groups and causes of death to changes in life expectancy over time, and to the inequality gap between the most and least deprived deciles in England.
Vaccinations (updated to July 2021)
People aged 50 and over who have received two vaccinations and people aged 50 and over who have not been vaccinated
Deaths (updated to July 2021)
Deaths involving COVID-19, where it was mentioned anywhere on the death certificate
Hospital admissions (updated to May 2021)
Admissions where COVID-19 was the primary reason for the patient being taken into hospital
Confirmed cases (updated to July 2021)
Cases of COVID-19 confirmed by having at least one positive test result
For deaths, hospital admissions and confirmed cases, the tool provides monthly and cumulative age-standardised rates, and monthly numbers. For vaccination uptake, cumulative percentages are provided. Inequality in life expectancy is measured using the Slope Index of Inequality (SII).
Confidence intervals are not displayed in the charts but are available from the Data Tables and can be downloaded with the rates, percentages and SII estimates.
For deaths, hospital admissions and confirmed cases, data are presented for England and the English regions. Within each of these geographies, the following breakdowns are available:
- Deprivation deciles
- Deprivation deciles - Under 75s
- Population density deciles
- Broad ethnic groups
More detailed ethnic groups for the Asian and Black groups are available for England only.
Rates for ethnic groups within regions are all cumulative, rather than being available by month. However, monthly counts have been provided.
For vaccination uptake, the following breakdowns are available within England and the English regions:
- Age group
- Deprivation quintile
- Ethnic group
- Country of birth
- Disability status
- Educational attainment
- Household tenure
The life expectancy estimates are available by deprivation decile within England and the English regions.
Publication 4: 09/09/2021
- New indicators for non-COVID-19 deaths, all cause deaths, life expectancy and life expectancy breakdowns
- Existing indicators for COVID-19 deaths, hospital admissions, confirmed cases and vaccinations updated
Publication 3: 05/08/2021
- New indicators for vaccination coverage in those aged 50 and over added
- New inequality breakdown showing population density deciles added for deaths, hospital admissions and confirmed cases
- Existing indicators for deaths, hospital admissions and confirmed cases updated
Publication 2: 24/06/2021
- New indicators for confirmed cases of COVID-19 added
- Existing indicators for deaths and hospital admissions updated
Publication 1: 20/05/2021
- CHIME tool launched with indicators for deaths involving COVID-19 and hospital admissions where COVID-19 was primary reason for the admission
- Inequality breakdowns include age, sex, ethnic group, level of deprivation and region
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 CHIME tool brings together data relating to the impacts of COVID-19, for factors such as mortality rates, hospital admissions, confirmed cases, vaccinations and life expectancy.
It presents the cumulative picture for the pandemic to date and data by month, and includes breakdowns by region, sex, age group, ethnicity, deprivation and population density. The vaccination data includes further breakdowns by country of birth, disability status, educational attainment, National Statistics Socio-economic Classification (NS-SEC), religion, rural-urban residency, and household tenure.
Indicators for the following themes are included:
- Vaccination coverage
- Deaths from all causes (including COVID-19)
- COVID-19 deaths (COVID-19 recorded on the death certificate)
- Non-COVID-19 deaths (COVID-19 not recorded on death certificate)
- Hospital admissions (COVID-19 primary reason for the admission)
- Confirmed cases (cases confirmed by at least one positive test)
- Life expectancy and inequality in life expectancy
Based on data from the Office for National Statistics (which covers a subset of the total population) by the end of July 2021, 93.0% of those aged 50 and over in England had received two vaccines, and 5.3% remained unvaccinated.
There was little difference in uptake between men and women, however there were large inequalities between other population groups.
The Black Caribbean ethnic group had the lowest proportion of its population to have been double vaccinated by the end of July 2021, followed by the Black African and Pakistani groups. Only 67.4% of the Black Caribbean group had received two doses, compared with 94.6% of White British, the group with the highest proportion.
Across the English regions, the White British group had the highest percentage of double vaccinated over 50s, and the Black African and Black Caribbean groups were generally lowest. The group with the highest proportion still unvaccinated was the Black Caribbean group in London, where 31.5% of over 50s had not yet received a first dose by the end of July 2021.
English language proficiency and country of birth
The proportion of over 50s who were double vaccinated was higher for those with English as their main language: 80.4% of those for whom English was not their main language (at the time of the 2011 Census) had had two vaccines by end of July 2021, compared to 93.7% of those for whom English was their main language. The proportion of double vaccinated people was 94.3% for those born in the UK, compared with 83.7% for those born outside the UK.
People who reported their religion as Muslim in the 2011 Census had the lowest proportion of over 50s who were double vaccinated. Only 79.9% of people whose religion was Muslim had had two vaccines by the end of July 2021 (up from 76.5% at end of June) compared with 94.2% of people whose religion was Christian (the religious group with the highest percentage).
National Statistics Socio-economic Classification and level of deprivation
People who had never worked or were long term unemployed at the time of the 2011 Census, were much more likely to be unvaccinated at the end of July 2021: 14.0% of over 50s in this group had not been vaccinated, while the proportions for people in all other occupational groups ranged between 4.1% and 5.9%.
The proportion of over 50s who had been double vaccinated increased with each decrease in level of deprivation. In the most deprived quintile 88.4% had received two doses of the vaccine compared with 95.6% in the least deprived quintile.
London was the region with the lowest uptake of vaccination in the over 50s. At the end of July 2021, 10.9% remained unvaccinated, while in all other regions this figure was below 5.5%. Only 86.4% of Londoners aged 50 and over were double vaccinated, compared with all other regions where this figure was at least 92%.
Deaths, Hospital Admissions and Confirmed Cases
Trends over time
There were two peaks in monthly COVID-19 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 COVID-19 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. Furthermore, confirmed cases have risen sharply since May 2021.
The trend for deaths from all causes largely mirrors that for deaths involving COVID-19 but the trend for non-COVID-19 deaths is different. There was an increase in the non-COVID-19 mortality rate between March and April 2020, but in May 2020 the rate fell to a level substantially below March 2020 and rates have remained lower since then. The increase in April 2020 may have resulted from some deaths caused by the coronavirus not being recorded as COVID-19 deaths in the early weeks of the pandemic.
Age and sex
Across the course of the pandemic in England, cumulative hospital admission and COVID-19 mortality rates were higher for males than females. In the pandemic period presented to date, the mortality rate in males was 1.7 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 July 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 COVID-19 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 10.6 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. The cumulative rate up to the end of July 2021 was highest for those aged 25-49, having surpassed those aged 85 and over, who had the highest cumulative rate until June 2021. 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 COVID-19 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 the North East, and lowest in the South West.
In England as a whole, the monthly COVID-19 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 COVID-19 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 COVID-19 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.
The picture is different for non-COVID-19 mortality rates. Across the pandemic to date, London had the lowest non-COVID-19 mortality rate of all the English regions.
Over the course of the pandemic to July 2021, the Asian ethnic group had the highest confirmed case rate, 1.5 times the rate for the Mixed ethnic group, which had the lowest rate. The cumulative confirmed case rate for the Black ethnic group was 1.3 times the rate for the Mixed ethnic group. Among the Asian groups, the Pakistani and Bangladeshi groups had the highest confirmed case rates.
The highest cumulative admission and COVID-19 mortality rates were in the Asian and Black groups. The hospital admission rate for the Asian and Black 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 COVID-19 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 COVID-19 mortality rate at the peak of the first wave, whereas the Asian group had the highest 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 COVID-19 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 4.0 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 COVID-19 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 2.9 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.
For deaths from all causes (which includes deaths involving COVID-19) the highest cumulative mortality rates to July 2021 were in the Black and Asian groups. Unlike the cumulative rates for COVID-19 deaths however, the White group did not have the lowest rate. Instead the lowest cumulative all cause rates were in the Other and Mixed ethnic groups.
The picture is different for non-COVID-19 mortality rates. The White group had the highest cumulative mortality rate to July 2021, followed by the Black and Asian groups, with the lowest rates in the Other and Mixed groups. The mortality rate was 1.4 times higher for the White group compared with the Mixed group.
There was a gradient in confirmed case rates, hospital admissions and COVID-19 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 3.0 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 1.5 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 COVID-19 mortality rate and confirmed case rate in the most deprived were both much higher than for all other deprivation groups.
Inequalities in COVID-19 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.
The impact of the pandemic has been greatest on those living in the most densely populated areas. Across the pandemic to date, the cumulative hospital admission rate for those in the most densely populated areas in England was 3.7 times the rate for those in the least densely populated areas, and the COVID-19 mortality rate over this period was 2.4 times higher. The level of inequality was narrower for confirmed cases, but the rate for the second and third most densely populated areas was still 1.5 times that for the least densely populated areas.
In most regions, there was a general increase in rates as population density increased, but the picture is not so straightforward in the North East and, in particular, in London. As London is almost entirely urban, dividing it into population density groups within the city results in some outcomes which are inconsistent with those seen in most other regions and England as a whole.
Trends in life expectancy
In 2020, life expectancy for both sexes in England was lower than in each of the previous 5 years. Compared with 2019, life expectancy in 2020 fell by 1.3 years for males and 0.9 years for females. All English regions had falls in life expectancy between 2019 and 2020, but the biggest falls were in London: 2.5 years for males and 1.6 years for females. In the South West, male life expectancy fell by only 0.6 years and in the East of England there was a fall of only 0.7 years for females. The falls in life expectancy in 2020 were almost entirely a result of deaths from COVID-19.
Inequalities in life expectancy
Life expectancy fell across all deprivation deciles in England in 2020, compared with the same period in 2019. Inequality in life expectancy for England increased for both males and females. The gap in male life expectancy between the most and least deprived in England was 10.3 years in 2020, 1 year larger than in 2019. For females, the gap was 8.3 years in 2020, 0.6 years larger than in 2019.
COVID-19 was the cause of death that contributed most to this gap. However, higher mortality from heart disease, lung cancer, and chronic lower respiratory diseases in deprived areas were also important reasons for the gap in life expectancy in both 2019 and 2020.
At regional level, there was variation in the trend in inequality between 2019 and 2020, however in all regions COVID-19 made the largest contribution to the gap in 2020.