The Income Gradient in Mortality during the Covid-19 Crisis: Evidence from Belgium

We use population-wide data from linked administrative registers to study the distributional pattern of mortality before and during the first wave of the Covid-19 pandemic in Belgium. Over the March-May 2020 study period, excess mortality is only found among those aged 65 and over. For this group, we find a significant negative income gradient in excess mortality, with excess deaths in the bottom income decile more than twice as high as in the top income decile for both men and women. However, given the high inequality in mortality in normal times, the income gradient in all-cause mortality is only marginally steeper during the peak of the health crisis when expressed in relative terms. Leveraging our individual-level data, we gauge the robustness of our results for other socioeconomic factors and decompose the role of individual vs. local effects. We provide direct evidence that geographic location effects on individual mortality are particularly strong during the first wave of the Covid-19 pandemic, channeling through the local number of Covid infections. This makes inference about the income gradient in excess mortality based on geographic variation misguided. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10888-021-09505-7.