Despite substantial improvement in mortality rates over time, significant inequalities across socio-economic and ethnic groups remain

September 15, 2022

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Social Inclusion and Equality
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Research published today by the Economic and Social Research Institute (ESRI) – funded by the Institute of Public Health (IPH) – has found that while mortality rates have fallen substantially over time in Ireland, inequalities between different groups in the population remain a concern. The research examined inequalities in mortality in Ireland over the period since 2000, focusing on two broad dimensions of inequality: socio-economic status (SES), and ethnicity/country of birth/nationality. An analysis of emerging patterns in relation to COVID-19 mortality was also undertaken.

Key Findings:

  • The study shows that the crude mortality rate for those aged 15+ declined from 10.5 per 1,000 population in 2000 to 8.1 in 2018, with males having higher rates than females throughout the period.
  • In 2000, 41 per cent of adult deaths were due to circulatory disease, with cancers (25 per cent), respiratory disease (16 per cent) and other causes (18 per cent) accounting for the remainder of deaths. By 2018, the proportion of total deaths attributed to circulatory disease (29 per cent) had declined sharply, while there was also a decline in the share of deaths accounted for by respiratory disease (to 13 per cent). The proportion of deaths attributable to cancers (30 per cent) and other causes (28 per cent) had a corresponding increase.
  • The analysis of SES inequalities showed that the standardised mortality rate for those in the least advantaged socio-economic group was twice as high as those in the most advantaged group in 2018.
  • An analysis of adult inequalities across ethnic, country of birth and nationality groups revealed a substantially lower mortality rate in non-White Irish ethnic groups, as well as in those born outside Ireland or with non-Irish nationality.
  • There has been a substantial decline in the perinatal mortality rate (the number of stillbirths and deaths in the first week of life per 1,000 births) since 2000; the rate declined from 8.3 in 2000 to 5.4 in 2019.
  • However, this improvement was not experienced equally by all groups. The perinatal mortality rate for unemployed mothers was between 1.6 and 2.2 times the rate of mothers in the higher professional group, and this rate remained elevated throughout the period 2000-2019.
  • African-born mothers experienced significantly higher rates of perinatal mortality throughout the period (between 1.5 and 2 times higher than mothers born in Ireland).
  • Analysis of COVID-19 mortality showed that for the period from March 2020 to May 2021, those in less advantaged socio-economic groups accounted for higher proportions of deaths relative to their shares in the population aged 65 and older.
  • While the numbers of COVID-19 deaths in non-White groups were very small overall, those with Black or Asian Irish ethnicity and those born in the EU-East (or with EU-East nationality) accounted for slightly higher proportions of COVID-19 deaths than their respective shares in the population aged 65 and older. 

Commenting on the findings, Anne Nolan, one of the authors of the report said, "Life expectancy and mortality are some of the most widely available indicators of population health and social progress. In addition to being unfair, inequalities in mortality across population groups are a key policy concern as they are potentially avoidable. Despite the overall improvement in mortality rates in Ireland in recent decades, the findings in this report highlight a number of groups that are vulnerable to higher mortality rates, and which require policy attention."

Helen McEvoy, Director of Policy at the Institute of Public Health, commented, "This report updates our understanding of how social and economic disadvantage can influence when and how people died in Ireland over the past decade. The analyses reveal new insights but also starkly highlight the ongoing limitations of Irish data. A robust health information system is needed to better monitor health inequalities and to meet the health equity goals of policies like Healthy Ireland and Sláintecare."