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Objectives To test the hypothesis that ‘deaths of despair’, a marker of social suffering, was associated with greater support for Brexit in the UK’s 2016 EU referendum. Methods Cross local authority regression models of 2016 Brexit referendum vote shares for each local authority in England and Wales on changes in rates of suicide and drug-related deaths pre- (2005-2007) and post-recession (2014-2016), adjusting for several socioeconomic and demographic factors. Survey population: 345 local authorities in England and Wales. Results Greater mortality rates from deaths of despair were significantly associated with higher Brexit vote shares. In unadjusted models, an increase of 10 drug-related deaths per 100 000 associated with a 13.20 percentage point increase in Brexit votes (95% CI: 7.09 to 19.31), while an increase of 10 suicides per 100 000 was associated with a 9.93 percentage point increase in vote shares for Brexit (95% confidence interval 6.21 to 13.65). These associations are explained by local area-level economic and education factors. Conclusions Worsening external causes of death correlate with Brexit voting. Such deaths may serve as an early warning indicator for political instability. Key messages Prior research has shown correlations between deaths of despair and votes shares for Trump in the 2016 US presidential election. We extend this research to the UK, showing that greater mortality rates from deaths of despair were significantly associated with higher Brexit vote shares.

Deaths of despair and Brexit votes: cross-local authority statistical analysis in England and Wales