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. 2023 Sep 28;22(1):198.
doi: 10.1186/s12939-023-02019-w.

Social inequalities and COVID-19 mortality between neighborhoods of Bariloche city, Argentina

Mónica Serena Perner  1   2 , Andrés Trotta  3 , Usama Bilal  4   5 , Binod Acharya  4 , Harrison Quick  4   5 , Natalia Pacífico  3 , Romina Berazategui  6 , Marcio Alazraqui  3 , Ana V Diez Roux  4   5
Affiliations

Social inequalities and COVID-19 mortality between neighborhoods of Bariloche city, Argentina

Mónica Serena Perner et al. Int J Equity Health. .

Abstract

Background: The COVID-19 pandemic has shown how intraurban inequalities are likely to reinforce health and social inequalities. Studies at small area level help to visualize social inequialities hidden in large areas as cities or regions.

Aim: To describe the spatial patterning of COVID-19 death rates in neighborhoods of the medium-sized city of Bariloche, Argentina, and to explore its relationship with the socioeconomic characteristics of neighborhoods.

Methods: We conducted an ecological study in Bariloche, Argentina. The outcome was counts of COVID-19 deaths between June 2020 and May 2022 obtained from the surveillance system and georeferenced to neighborhoods. We estimated crude- and age-adjusted death rates by neighborhood using a Bayesian approach through a Poisson regression that accounts for spatial-autocorrelation via Conditional Autoregressive (CAR) structure. We also analyzed associations of age-adjusted death rates with area-level socioeconomic indicators.

Results: Median COVID-19 death rate across neighborhoods was 17.9 (10th/90th percentile of 6.3/35.2) per 10,000 inhabitants. We found lower age-adjusted rates in the city core and western part of the city. The age-adjusted death rate in the most deprived areas was almost double than in the least deprived areas, with an education-related relative index of inequality (RII) of 2.14 (95% CI 1.55 to 2.96).

Conclusion: We found spatial heterogeneity and intraurban variability in age-adjusted COVID-19 death rates, with a clear social gradient, and a higher burden in already deprived areas. This highlights the importance of studying inequalities in health outcomes across small areas to inform placed-based interventions.

Keywords: COVID-19; Small areas; Social inequalities; Spatial analysis; Urban health.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Crude and age-adjusted COVID-19 mortality rate per 10,000. Bariloche, Argentina. June 2020—May 2022. Footnote: legend has different cutpoints since crude and age-adjusted mortality rates are not directly comparable with each other. The box in the upper right margin refers to Argentina, in this map the Argentine Antarctica was omitted for graphic purposes
Fig. 2
Fig. 2
Scatterplot for the association between neighborhood socioeconomic indicators and age-adjusted COVID-19 age-adjusted mortality rate. Bariloche, Argentina. June 2020—May 2022
Fig. 3
Fig. 3
Spatial distribution of COVID-19 age-adjusted mortality rates and selected socioeconomic variables in Bariloche, Argentina. Footnote: In these maps the darker the light blue the higher the percentage of population with unmet basic needs or with overcrowding, and the darker the orange, the higher the age-adjusted COVID-19 mortality rate. The bivariate pallet shows areas of high concordance in brown and in light orange. Brown (high/high in the legend) represents the most unequal areas, high COVID-19 age-adjusted mortality rates and more deprived areas (high unmet basic needs or overcrowding); light orange in the other extreme (low/low in the legend), low COVID-19 age-adjusted mortality rates and less deprived areas (low unmet basic needs or overcrowding). The box in the upper right margin refers to Argentina, in this map the Argentine Antarctica was omitted for graphic purposes
See this image and copyright information in PMC

References

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