COVID-19 mortality with regard to healthcare services availability, health risks, and socio-spatial factors at department level in France: A spatial cross-sectional analysis

Abstract

Background The 2019 coronavirus (COVID-19) epidemic began in Wuhan, China in December 2019 and quickly spread to the rest of the world. This study aimed to analyse the associations between the COVID-19 mortality rate in hospitals, the availability of health services, and socio-spatial and health risk factors at department level. Methods and findings This spatial cross-sectional study used cumulative mortality data due to the COVID-19 pandemic in hospitals until 30 November 2020 as a main outcome, across 96 departments of mainland France. Data concerning health services, health risk factors, and socio-spatial factors were used as independent variables. Independently, we performed negative binomial, spatial and geographically weighted regression models. Our results revealed substantial geographic disparities. The spatial exploratory analysis showed a global positive spatial autocorrelation in each wave indicating a spatial dependence of the COVID-19 deaths across departments. In first wave about 75% of COVID-19 deaths were concentrated in departments of five regions compared to a total of 13 regions. The COVID-19 mortality rate was associated with the physicians density, and not the number of resuscitation beds. Socio-spatial factors were only associated with the COVID-19 mortality rate in first wave compared to wave 2. For example, the COVID-19 mortality rate increased by 35.69% for departments densely populated. Health risk factors were associated with the COVID-19 mortality rate depending on each wave. This study had inherent limitations to the ecological analysis as ecological bias risks and lack of individual data. Conclusions Our results suggest that the COVID-19 pandemic has spread more rapidly and takes more severe forms in environments where there is already a high level of vulnerability due to social and health factors. This study showed a different dissemination pattern of COVID-19 mortality between the two waves: a spatial non-stationarity followed by a spatial stationarity in the relationships between the COVID-19 mortality rate and its potential drivers.

Heterogeneity and district-level factors associated with COVID-19 mortality during three epidemic waves in Indonesia: a nationwide ecological study

“…found the absence of correlation between mortality rate with doctor to population ratio during the first six months of the epidemic [33], our district-level analysis found that a higher COVID-19 mortality rate was strongly associated with a lower number of doctors per 100,000 population at district-level. This finding contrasts a previous finding from a higher-income country, reporting an association between higher COVID-19 mortality rate with higher physicians density in France [34].…”

“…In contrast to a previous province-level analysis (n=34) found the absence of correlation between mortality rate with doctor to population ratio during the first six months of the epidemic [33], our district-level analysis found that a higher COVID-19 mortality rate was strongly associated with a lower number of doctors per 100,000 population at district-level. This finding contrasts a previous finding from a higher-income country, reporting an association between higher COVID-19 mortality rate with higher physicians density in France [34]. In Indonesia, the lack of doctors, combined with the high number of infections [35] and deaths among health care workers and doctors [36], especially during the early phase of the epidemic, had weakened the health system resilience.…”

Health and healthcare variables associated with Italy's excess mortality during the first wave of the COVID-19 pandemic: An ecological study

“… [23] and Tchicaya and coll. [24] focused on COVID-19, finding a negative association between the availability of medical personnel and mortality in Hubei province in China and France, respectively. It is worth noting that the density of doctors indicator includes both practising and non-practising physicians who were registered and entitled to practise as healthcare professionals.…”

Unraveling the Enzymatic Mechanism of the SARS-CoV-2 RNA-Dependent-RNA-Polymerase. An Unusual Active Site Leading to High Replication Rates

“…SARS-CoV-2 also shares structural and phylogenetic analogy with the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) emerged in 2012. Differently from its predecessors, SARS-CoV-2 has a lower mortality ratio (estimated at around 2-3 %) [6][7][8] and in some cases it develops asymptomatically, especially for its latest B.1.1.519 (omicron) variant. [9][10][11] However, its high contagiousness and the possible development of severe outcomes, especially in elder patients or subjects presenting comorbidities, has caused and still causes an impressive stress on the health systems, only mitigated by the development of novel vaccines also including the messenger RNA (mRNA) strategy.…”