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. 2022 Dec 12;22(1):2316.
doi: 10.1186/s12889-022-14774-6.

Socioeconomic differences in COVID-19 infection, hospitalisation and mortality in urban areas in a region in the South of Europe

Nicolás F Fernández-Martínez  1   2 , Rafael Ruiz-Montero  3   4 , Diana Gómez-Barroso  5   6 , Alejandro Rodríguez-Torronteras  1 , Nicola Lorusso  7 , Inmaculada Salcedo-Leal  1   2 , Luis Sordo  6   8
Affiliations

Socioeconomic differences in COVID-19 infection, hospitalisation and mortality in urban areas in a region in the South of Europe

Nicolás F Fernández-Martínez et al. BMC Public Health. .

Abstract

Background: To analyse differences in confirmed cases, hospitalisations and deaths due to COVID-19 related to census section socioeconomic variables. METHODS: Ecological study in the 12 largest municipalities in Andalusia (Spain) during the first three epidemic waves of the COVID-19 (02/26/20-03/31/21), covering 2,246 census sections (unit of analysis) and 3,027,000 inhabitants. Incidence was calculated, standardised by age and sex, for infection, hospitalisation and deaths based on average gross income per household (AGI) for the census tracts in each urban area. Association studied using a Poisson Bayesian regression model with random effects for spatial smoothing.

Results: There were 140,743 cases of COVID-19, of which 12,585 were hospitalised and 2,255 died. 95.2% of cases were attributed to the second and third waves, which were jointly analysed. We observed a protective effect of income for infection in 3/12 cities. Almeria had the largest protective effect (smoothed relative risk (SRR) = 0.84 (0.75-0.94 CI 95%). This relationship reappeared with greater magnitude in 10/12 cities for hospitalisation, lowest risk in Algeciras SRR = 0.41 (0.29-0.56). The pattern was repeated for deaths in all urban areas and reached statistical significance in 8 cities. Lowest risk in Dos Hermanas SRR = 0.35 (0.15-0.81).

Conclusions: Income inequalities by geographical area were found in the incidence of COVID-19. The strengths of the association increased when analysing the severe outcomes of hospitalisations and, above all, deaths.

Keywords: COVID-19; Geographical; Hospitalisation; Mortality; Socio-economic status; Urbanization.

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Conflict of interest statement

Luis Sordo is BMC Public Health associate editor. The other authors declare that they have no financial and/or non-financial interest in relation to this study.

Figures

Fig. 1
Fig. 1
Location of studied urban areas
Fig. 2
Fig. 2
Distribution of average gross income by household in the studied urban areas, by income quintiles
Fig. 3
Fig. 3
Smoothed relative risks for cases of infection (a), hospitalisation (b) and death (c) due to COVID-19, by household annual gross income, 2nd and 3rd waves
See this image and copyright information in PMC

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