Cookies on this website

We use cookies to ensure that we give you the best experience on our website. If you click 'Accept all cookies' we'll assume that you are happy to receive all cookies and you won't see this message again. If you click 'Reject all non-essential cookies' only necessary cookies providing core functionality such as security, network management, and accessibility will be enabled. Click 'Find out more' for information on how to change your cookie settings.

<jats:sec><jats:title>Objective</jats:title><jats:p> To estimate the proportion of ethnic inequalities explained by living in a multi-generational household. </jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p> Causal mediation analysis. </jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p> Retrospective data from the 2011 Census linked to Hospital Episode Statistics (2017-2019) and death registration data (up to 30 November 2020). </jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p> Adults aged 65 years or over living in private households in England from 2 March 2020 until 30 November 2020 (n=10,078,568). </jats:p></jats:sec><jats:sec><jats:title>Main outcome measures</jats:title><jats:p> Hazard ratios were estimated for COVID-19 death for people living in a multi-generational household compared with people living with another older adult, adjusting for geographic factors, socioeconomic characteristics and pre-pandemic health. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> Living in a multi-generational household was associated with an increased risk of COVID-19 death. After adjusting for confounding factors, the hazard ratios for living in a multi-generational household with dependent children were 1.17 (95% confidence interval [CI] 1.06–1.30) and 1.21 (95% CI 1.06–1.38) for elderly men and women. The hazard ratios for living in a multi-generational household without dependent children were 1.07 (95% CI 1.01–1.13) for elderly men and 1.17 (95% CI 1.07–1.25) for elderly women. Living in a multi-generational household explained about 11% of the elevated risk of COVID-19 death among elderly women from South Asian background, but very little for South Asian men or people in other ethnic minority groups. </jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p> Elderly adults living with younger people are at increased risk of COVID-19 mortality, and this is a contributing factor to the excess risk experienced by older South Asian women compared to White women. Relevant public health interventions should be directed at communities where such multi-generational households are highly prevalent. </jats:p></jats:sec>

Original publication




Journal article


Journal of the Royal Society of Medicine


SAGE Publications

Publication Date



014107682199997 - 014107682199997