Religious affiliation and COVID-19-related mortality: a retrospective cohort study of prelockdown and postlockdown risks in England and Wales

  1. Charlotte Hannah Gaughan
  2. Daniel Ayoubkhani
  3. Vahe Nafilyan
  4. Peter Goldblatt
  5. Chris White
  6. Karen TIngay
  7. Neil Bannister

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Abstract

COVID-19 mortality risk is associated with demographic and behavioural factors; furthermore, religious gatherings have been linked with the spread of COVID-19. We sought to understand the variation in risk of COVID-19-related death across religious groups in England and Wales both before and after the first national lockdown.

Methods

We conducted a retrospective cohort study of usual residents in England and Wales enumerated at the 2011 Census (n=47 873 294, estimated response rate 94%) for risk of death involving COVID-19 using linked death certificates. Cox regression models were estimated to compare risks between religious groups. Time-dependent coefficients were added to the model allowing HRs before and after lockdown period to be estimated separately.

Results

Compared with Christians, all religious groups had an elevated risk of death involving COVID-19; the largest age-adjusted HRs were for Muslim and Jewish males at 2.5 (95% CI 2.3 to 2.7) and 2.1 (95% CI 1.9 to 2.5), respectively. The corresponding HRs for Muslim and Jewish females were 1.9 (95% CI 1.7 to 2.1) and 1.5 (95% CI 1.7 to 2.1), respectively. The difference in risk between groups contracted after lockdown. Those who affiliated with no religion had the lowest risk of COVID-19-related death before and after lockdown.

Conclusion

The majority of the variation in COVID-19 mortality risk was explained by controlling for sociodemographic and geographic determinants; however, those of Jewish affiliation remained at a higher risk of death compared with all other groups. Lockdown measures were associated with reduced differences in COVID-19 mortality rates between religious groups; further research is required to understand the causal mechanisms.

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  1. ScreenIT

    SciScore for 10.1101/2020.10.01.20204495: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variableSeparate models were estimated for males and females.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    A limitation of our study that the data were taken from the 2011 Census. Whilst using variables from 2011 for a population at risk of COVID 19 related death in 2020 is not ideal, it seems unlikely that religious affiliation will change over this period for the majority of people, although the extent to which they practice may do. Similarly, whilst the socio demographic factors included in our models may of course evolve over time for the individual, a significant shift in the profile of a religious group over the last nine years seems unlikely; for example, analysis of data from the Annual Population Survey (APS) [16] showed that between 2012 and 2019, the socio economic make-up of religious groups has generally not changed (see supplementary table 6). However, key worker status is likely to be out of date for a proportion of the population. It could also be the case that religious communities centre around religious buildings and not move over time so it is likely the geographical measures are accurate for people who most strongly practice their religion; furthermore, population density is reflective of the situation in 2018. The main problem is defining what religious affiliation at the 2011 Census is in practise measuring; in an ideal world the effect of religion would be specific to religious practices, however we are unable to observe the extent of religious practises in this study. Whilst we may not have adjusted for all the socio-demographic determinants of religion, a...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We found bar graphs of continuous data. We recommend replacing bar graphs with more informative graphics, as many different datasets can lead to the same bar graph. The actual data may suggest different conclusions from the summary statistics. For more information, please see Weissgerber et al (2015).

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  2. Version published to 10.1136/jech-2020-215694
  3. Version published to 10.1101/2020.10.01.20204495v1 on medRxiv