# Socio-economic inequalities in all-cause mortality during the COVID-19 period in north-western Tanzania, 2018–2021

## TL;DR

The study found that vulnerable groups in north-western Tanzania faced higher mortality risks during the COVID-19 pandemic, despite overall mortality rates declining.

## Contribution

This study provides population-level evidence on sociodemographic inequalities in mortality during the pandemic in a low-income setting.

## Key findings

- Mortality risk was significantly higher for children under five and older adults during the pandemic.
- Males had a higher risk of death compared to females during the pandemic.
- Socioeconomic disparities in mortality increased during the pandemic period.

## Abstract

Evidence suggests that the COVID-19 pandemic has exacerbated social and demographic inequalities in the communities through pathways of unequal exposure, vulnerability, and susceptibility. In Tanzania, evidence on COVID-19-related mortality is limited to health facility data, with little to no information on the mortality patterns in the general population. This study assessed sociodemographic inequalities in all-cause mortality during the COVID-19 period in north-western Tanzania.

We utilized available longitudinal data from the Magu Health and Demographic Surveillance System (HDSS) from January 2018 to December 2021. We compared the crude death rates between subgroups of age, sex, area of residence, and wealth index for a period before (2018/2019) and during (2020/2021) the COVID-19 pandemic. To quantify how mortality risk varies across the subgroups we fitted a Cox proportional hazard model with an interaction of the COVID-19 period.

Overall mortality declined from 5.9 in 2018/2019 to 5.4 and 5.5 deaths per 1000 person-years in 2020 and 2021, respectively. We observed an increase in differences in crude death rates by age groups, area of residence, and wealth quintiles during the COVID-19 period. In the Cox proportional hazards model, compared to adults aged 15–49, we observed greater mortality risk in children under five (AHR:2.9; 95%CI: 2.2–3.9), older individuals aged 50–64 years (AHR:3.02; 95%CI:2.11–4.33) and 65 + (AHR:18.65; 95%CI:14.28–24.35) during COVID-19 period. Males were also at greater risk of death compared to females (AHR:1.30; 95%CI:1.06–1.59).

Despite the overall mortality decline during the pandemic, we observed an increased risk of mortality among vulnerable subgroups (aged < 5 years and > 60 years) in the population. This highlights the need to take into account vulnerable subpopulations when addressing major public health issues in communities.

The online version contains supplementary material available at 10.1186/s12963-025-00390-0.