Impact of social and demographic factors on the spread of the SARS-CoV-2 epidemic in the town of Nice

Abstract

Introduction: Socio-demographic factors are known to influence epidemic dynamics. The town of Nice, France, displays major socio-economic inequalities, according to the National Institute of Statistics and Economic Studies (INSEE), 10% of the population is considered to live below the poverty threshold, i.e. 60% of the median standard of living.

Objective: To identify socio-economic factors related to the incidence of SARS-CoV-2 in Nice, France.

Methods: The study included residents of Nice with a first positive SARS-CoV-2 test (January 4-February 14, 2021). Laboratory data were provided by the National information system for Coronavirus Disease (COVID-19) screening (SIDEP) and socio-economic data were obtained from INSEE. Each case's address was allocated to a census block to which we assigned a social deprivation index (French Deprivation index, FDep) divided into 5 categories. For each category, we computed the incidence rate per age and per week and its mean weekly variation. A standardized incidence ratio (SIR) was calculated to investigate a potential excess of cases in the most deprived population category (FDep5), compared to the other categories. Pearson's correlation coefficient was computed and a Generalized Linear Model (GLM) applied to analyse the number of cases and socio-economic variables per census blocks.

Results: We included 10,078 cases. The highest incidence rate was observed in the most socially deprived category (4001/100,000 inhabitants vs 2782/100,000 inhabitants for the other categories of FDep). The number of observed cases in the most social deprivated category (FDep5: N = 2019) was significantly higher than in the others (N = 1384); SIR = 1.46 [95% CI:1.40-1.52; p < 0.001]. Socio-economic variables related to poor housing, harsh working conditions and low income were correlated with the new cases of SARS-CoV-2.

Conclusion: Social deprivation was correlated with a higher incidence of SARS-CoV-2 during the 2021 epidemic in Nice. Local surveillance of epidemics provides complementary data to national and regional surveillance. Mapping socio-economic vulnerability indicators at the census block level and correlating these with incidence could prove highly useful to guide political decisions in public health.

Trial registration: ClinicalTrials.gov NCT05379621.

Keywords: COVID-19; Incidence; Risk factors; Social inequalities.

Fig. 1

Flow chart

Fig. 2

Weekly SARS-CoV-2 incidence rate in Nice, Alpes-Maritimes and France during the study period

Fig. 3

Distribution of the social deprivation index (FDep) across the town of Nice

Fig. 4

Weekly SARS-CoV-2 incidence rate in Nice according to social deprivation category

Fig. 5

Incidence rate over the study period per age group according to social deprivation category