A Poorly Understood Disease? The Unequal Distribution of Excess Mortality Due to COVID-19 Across French Municipalities<sup>*</sup>

Brandily, Paul; Brébion, Clément; Briole, Simon; Khoury, Laura

doi:10.1101/2020.07.09.20149955

Cited by 24 publications

(18 citation statements)

References 27 publications

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“…Likewise, it was also partly an effect of their economic precariousness since the OR of the working class decreased when it was adjusted for this variable. The latter result is consistent with economists’ work that has recently established that “the prevalence of the epidemic was higher in the poorer communes in France [ 21 ]. We also found that living in housing with less than one room per person tended to be linked to the risk of having been infected.…”

Section: Discussionsupporting

confidence: 90%

When lockdown policies amplify social inequalities in COVID-19 infections: evidence from a cross-sectional population-based survey in France

et al. 2021

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Background Significant differences in COVID-19 incidence by gender, class and race/ethnicity are recorded in many countries in the world. Lockdown measures, shown to be effective in reducing the number of new cases, may not have been effective in the same way for all, failing to protect the most vulnerable populations. This survey aims to assess social inequalities in the trends in COVID-19 infections following lockdown. Methods A cross-sectional survey conducted among the general population in France in April 2020, during COVID-19 lockdown. Ten thousand one hundred one participants aged 18–64, from a national cohort who lived in the three metropolitan French regions most affected by the first wave of COVID-19. The main outcome was occurrence of possible COVID-19 symptoms, defined as the occurrence of sudden onset of cough, fever, dyspnea, ageusia and/or anosmia, that lasted more than 3 days in the 15 days before the survey. We used multinomial regression models to identify social and health factors related to possible COVID-19 before and during the lockdown. Results In all, 1304 (13.0%; 95% CI: 12.0–14.0%) reported cases of possible COVID-19. The effect of lockdown on the occurrence of possible COVID-19 was different across social hierarchies. The most privileged class individuals saw a significant decline in possible COVID-19 infections between the period prior to lockdown and during the lockdown (from 8.8 to 4.3%, P = 0.0001) while the decline was less pronounced among working class individuals (6.9% before lockdown and 5.5% during lockdown, P = 0.03). This differential effect of lockdown remained significant after adjusting for other factors including history of chronic disease. The odds of being infected during lockdown as opposed to the prior period increased by 57% among working class individuals (OR = 1.57; 95% CI: 1.00–2.48). The same was true for those engaged in in-person professional activities during lockdown (OR = 1.53; 95% CI: 1.03–2.29). Conclusions Lockdown was associated with social inequalities in the decline in COVID-19 infections, calling for the adoption of preventive policies to account for living and working conditions. Such adoptions are critical to reduce social inequalities related to COVID-19, as working-class individuals also have the highest COVID-19 related mortality, due to higher prevalence of comorbidities.

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Section: Discussionsupporting

confidence: 90%

When lockdown policies amplify social inequalities in COVID-19 infections: evidence from a cross-sectional population-based survey in France

et al. 2021

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“…Similarly, our study did not exhibit any significant association between economic indicators and in-hospital COVID-19 incidence or mortality at the department level. This contrasts with a recently pre-published study that showed a larger impact of the pandemic on overall mortality in the poorest of the 35,000 French municipalities (62). The spatial scale of our analysis (department level) may have been too wide to identify such an association.…”

Section: Discussioncontrasting

confidence: 94%

Factors associated with the spatial heterogeneity of COVID-19 in France: a nationwide ecological study

Gaudart

Landier

Huiart

et al. 2020

Preprint

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Like in many countries and regions, spread of the COVID 19 pandemic has exhibited important spatial heterogeneity across France, one of the most affected countries so far. To better understand factors associated with incidence, mortality and lethality heterogeneity across the 96 administrative departments of metropolitan France, we thus conducted a geoepidemiological analysis based on publicly available data, using hierarchical ascendant classification (HAC) on principal component analysis (PCA) of multidimensional variables, and multivariate analyses with generalized additive models (GAM). Our results confirm a marked spatial heterogeneity of in-hospital COVID 19 incidence and mortality, following the North East / South West diffusion of the epidemic. The delay elapsed between the first COVID-19 associated death and the onset of the national lockdown on March 17th, 2020, appeared positively associated with in-hospital incidence, mortality and lethality. Mortality was also strongly associated with incidence. Mortality and lethality rates were significantly higher in departments with older population, but they were not significantly associated with the number of intensive-care beds available in 2018. We did not find any significant association between incidence, mortality or lethality rates and incidence of new chloroquine and hydroxychloroquine dispensations in pharmacies either, nor between COVID 19 incidence and climate, nor between economic indicators and in-hospital COVID 19 incidence or mortality. This ecological study highlights the impact of population age structure, epidemic spread and transmission mitigation policies in COVID-19 morbidity or mortality heterogeneity.

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“…Our results show that this overexposure during lockdown was partly a result of their health status (smoking and history of chronic disease and obesity). It was also partly an effect of their economic precariousness since the OR of the working class decreased when it was adjusted on this variable, a result consistent with economic work that has recently been established at a macroeconomic level in France 18 . We also found that living in housing with less than one room per person tended to be linked to the risk of having been contaminated.…”

Section: Discussionsupporting

confidence: 71%

When lockdown policies amplify social inequalities in COVID-19 infections. Evidence from a cross-sectional population-based survey in France

Bajos

Jusot

Pailhé

et al. 2020

Preprint

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Objectives To assess social inequalities in the trends in COVID-19 infections following lockdown Design A cross-sectional survey conducted among the general population in France in April 2020, during COVID-19 lockdown. Participants 10 401 participants aged 18-64, from a national cohort who lived in the three metropolitan French regions most affected by the first wave of COVID-19. Main outcome The main outcome was occurrence of possible COVID-19 symptoms, defined as the occurrence of sudden onset of cough, fever, dyspnea, ageusia and/or anosmia, that lasted more than three days in the 15 days before the survey. We used multinomial regression models to identify social and health factors related to possible COVID-19 before and during the lockdown. Results In all, 1,304 (13.0%; 95% CI: 12.0%-14.0%) reported cases of possible COVID-19. The effect of lockdown on the occurrence of possible COVID-19 was different across social hierarchies. The most privileged class individuals saw a significant decline in possible COVID-19 infections between the period prior to lockdown and during the lockdown (from 8.8% to 4.3%, P=0.0001) while the decline was less pronounced among working class individuals (6.9% before lockdown and 5.5% during lockdown, P=0.03). This differential effect of lockdown remained significant after adjusting for other factors including history of chronic disease. The odds of being contaminated during lockdown as opposed to the prior period increased by 57% among working class individuals (OR=1.57; 95% CI: 1.0-2.48). The same was true for those engaged in in-person professional activities during lockdown (OR=1.53; 95% CI: 1.03-2.29). Interpretation Lockdown was associated with social inequalities in the decline in COVID-19 infections, calling for the adoption of preventive policies to account for living and working conditions. Such adoptions are critical to reduce social inequalities related to COVID-19, as working-class individuals also have the highest COVID-19 related mortality, due to higher prevalence of comorbidities.

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A Poorly Understood Disease? The Unequal Distribution of Excess Mortality Due to COVID-19 Across French Municipalities^*

Cited by 24 publications

References 27 publications

When lockdown policies amplify social inequalities in COVID-19 infections: evidence from a cross-sectional population-based survey in France

When lockdown policies amplify social inequalities in COVID-19 infections: evidence from a cross-sectional population-based survey in France

Factors associated with the spatial heterogeneity of COVID-19 in France: a nationwide ecological study

When lockdown policies amplify social inequalities in COVID-19 infections. Evidence from a cross-sectional population-based survey in France

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A Poorly Understood Disease? The Unequal Distribution of Excess Mortality Due to COVID-19 Across French Municipalities*

Cited by 24 publications

References 27 publications

When lockdown policies amplify social inequalities in COVID-19 infections: evidence from a cross-sectional population-based survey in France

When lockdown policies amplify social inequalities in COVID-19 infections: evidence from a cross-sectional population-based survey in France

Factors associated with the spatial heterogeneity of COVID-19 in France: a nationwide ecological study

When lockdown policies amplify social inequalities in COVID-19 infections. Evidence from a cross-sectional population-based survey in France

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Product

Resources

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A Poorly Understood Disease? The Unequal Distribution of Excess Mortality Due to COVID-19 Across French Municipalities^*