Mortality from CoVid amongst Jews

[First circulated 29th June 2020]

Widely reported in both the Jewish and non-Jewish press was the high mortality from Covid amongst Jews in England and Wales.  This brief paper summarises the data, what is known and what is not known.

The study data : 

The Office for National Statistics in England and Wales linked the names on the death certificates that mentioned CoVid occurring between 2^nd March and 15^th May to those individuals’ self-reported religion on the 2011 census

The denominator was the total who self-reported one of the nine different religious groupings (including no religion) in that census

For each person who died the research also extracted from the census data:

• Age
• Gender
• Self-reported ethnicity-ie white/non-white (not relevant for Jews but is important in comparing with data from Muslims 
• Various indices of socio-economic deprivation
• Self-reported health 

Comment: The number of Jews from the 2011 census amounts to 0.5% of the population.  Obviously like any estimate it is subject to errors. 

 Analysis

The research calculated the numbers of deaths per 100,000 in each religious group, separately by gender, overall and divided into those above and below 65.

They then calculated a full age-adjusted analysis to  compare these rates with the rate in Christians and other religions (including those who declared no religion).

Comment: The analysis was a standard epidemiological analysis.  One concern might be that using Christian as the comparator might be based on a very selective part of  the population.  In fact, 60% of the England and Wales population declared themselves as Christian in 2011 compared to just 7% who did not state their religion

The results 

There were a total of 453 deaths in people who were identified as Jewish on the 2011 census, 23 were aged 64 and under  and 430 above that age.  268 were males and 185 were female.  

The headline rates of deaths per 100,000, after adjusting for the age distribution of the population were  as below:

	Males:	Females:
Jews	187.7	98.2
Muslims	198.9	94.3
Hindus	154.8	93.3
Christians	92.6	54.6

* Note that the death rates for those with no religion or not prepared to say were similar  to the Christian population

• Restricting the data to just the population aged over 64, this was the ranked order of deaths, taking account of the age structure, by religion

Ordered by highest death rate	Males:	Females:
1st	Jews	Jews
2nd	Muslim	Muslim
3rd	Hindu	Hindu
4th	Sikh	Sikh

• Restricting the data to just the population aged 64 and under this was the ranked order, taking account of the age structure of deaths by religion

Ordered by highest death rate	Males:	Females:
1st	Muslim	Muslim
2nd	Hindu	Hindu
3rd	Sikh	Sikh
4th	Jewish	Christian

 * Note that the number of female deaths under the age of 65 was too small for some religions (including Jewish women and thus age-adjusted rates were not calculated  

• After allowing for socio-economic and other indices of deprivation and self-reported ill health at the 2011 census this was the ranked order:

Ordered by highest death rate	Males:	Females:
1st	Muslim	Muslim
2nd	Jewish	Hindu
3rd	Hindu	Jewish
4th	Sikh	Sikh

Comment: There is no doubt that Jews have a much higher death rate from CoVid than the background Christian population and indeed were similar to, or higher than, other religious groups This analysis takes into account that some of the differences in death rates may reflect differences in factors such as poverty and overcrowding.    Indeed, the death rate in Jewish males was still approximately twice that in Christians.  Although British Jews as a group may be better off economically, there are those in the growing Charedi community who are poorer and more overcrowded.  This analysis takes account of these differences 

The above analysis was repeated after allowing for self-reported ethnicity ie white/non-white.  This was the result:

Ordered by highest death rate	Males:	Females:
1st	Jewish	Hindu
2nd	Muslim	Jewish
3rd	Hindu	Muslim
4th	Sikh	Christian

Comment: This in some ways is the most interesting result.  Whilst Jews virtually always describe themselves as being of  ‘white ethnicity’ this is not true for Muslims.  (Detailed figures are available). After allowing for the ethnicity question, the effect of Muslim religion is much diminished.  The interpretation is that it is not the Muslim religion that is associated with the higher death rates but the ethnic aspect (ie white Muslims are not at risk of higher death rates)

How should the results be interpreted?

These are death rates and reflect the combination both  of how common CoVid is (the ‘incidence’ rate’)  in the different religions and how likely sufferers will die (the ‘case fatality’) in those who contract the virus. 

Is the higher death rate in Jews due to a higher incidence, a higher case fatality (or a mixture of both)?

Of these two possibilities the second is the less likely.  It is known that in the UK, Jewish males have death rates about 40% lower from all causes than the background population with females about 20-30% lower. Thus, British  Jews live longer with, for example, approximately twice as many being over 85 as the background population.  Also, though  not comparing like with like, Israel has one of the highest life expectancies in the world- being similar to Switzerland and Singapore

Thus, the more likely conclusion must be that there is (or was) a higher incidence of CoVid in Jews, rather than a higher case fatality 

It could be debated as to whether this was due to (i) being more likely to be exposed to the virus because of increased likelihood of social contact with an infected individual, and/or (ii) once exposed being more likely to get an actual infection with the same level of contacts.  Theoretically the latter is possible: ie  that Jews are less likely to remain asymptomatic for example are less likely to have pre-existing immunity. There are no data on this.

But one intriguing unanswered question!

In all the analyses on deaths, Jewish males have twice the age adjusted death rate as Jewish females.  That there is an excess death rate from CoVid in UK males  is well described and publicised but the data on Jews are different.  Indeed, Jewish males have around 2.2 times the death rate  of Christian males, whereas Jewish females have only about 1.5 times the death rate of Christian females.  Is it as simple as Jewish men spending more time mixing with each other??