Deprivation effect on COVID-19 cases incidence and severity: a geo-epidemiological study in PACA region, France

Abstract

Introduction. The spread of the COVID-19 pandemic, and its severity, is spatially heterogenous. At the individual level, the socioeconomic status (SES) profile is known to be associated with COVID-19 incidence and severity. The aim of this geo epidemiological study was to investigate the link between SES profile and potential confounders, and COVID-19 incidence and hospitalization rates, at a fine geographical scale. Methods. We analyzed COVID-19 incidence and severity during two epidemic waves between September 2020 and June 2021, in Provence Alpes Cotes d Azur, a 5 million inhabitants French region. The region is divided into sub-municipal areas that we have classified according to their SES profile. We then conducted a spatial analysis of COVID-19 indicators depending on SES profile, age structure, and health services provision. This analysis considered spatial autocorrelation between areas. Results. COVID-19 incidence rates in more deprived areas were similar to those in wealthiest ones. Hospitalization rates of COVID-19 cases in conventional care units were greater in more deprived vs wealthiest areas: Standardized Incidence Ratio (SIR) were respectively 1.34 [95% confidence interval 1.18 - 1.52] and 1.25 [1.13 - 1.38] depending on the epidemic wave. This gap was even greater regarding hospitalization rates of cases in critical care units: SIR = 1.64 [1.30 - 2.07] then 1.33 [1.14 - 1.55] depending on the epidemic wave. Hospitalization rates of COVID-19 cases in conventional care units were also greater in areas with high proportion of elderly people vs young people: SIR respectively 1.24 [1.11 - 1.38] and 1.22 [1.13 - 1.32] depending on the wave. Conclusion. Considering age structure and health services provision, a deprived SES profile is associated to a greater COVID-19 severity in terms of hospitals admissions, in conventional care units and in critical care units. This result implies targeting risk prevention efforts on these areas in pandemic situations and highlights the need to develop access to healthcare to deprived populations in anticipation of periods of crisis.

Social deprivation and SARS-CoV-2 testing: a population-based analysis in a highly contrasted southern France region

“…Our regional scale analysis based on socio-demographic profiles rather than national quintiles (France) or deciles (Switzerland) of deprivation indices allowed a precise characterization of local specific aspects: indeed, in our study region >30% of IRIS belonged to the highest deprivation quintile defined at French national level, respectively only 10% to the lowest quintile (Supplementary Figure S10). In PACA region, deprivation was also associated with higher severity in very deprived areas compared to privileged ones (28).…”

The Renunciation of Healthcare Services in the Italian Regions in the ESG Context

“…The high costs of specialist medical care due to the mix of corruption and informal payments increases the value of RHS in Italy [3]. Economic deprivation increased the value of RHS during the lockdowns in the Covid-19 pandemic in France [4]. RHS is positively related to retirement, chronic disease, financial difficulties and long-term unemployment [5].…”

“…RHS for economic reason [2][3][4][5][6][7][8][9] RHS and localization [10] RHS and Covid 19 [11,12] RHS and psychological disease [13][14][15][16] How to contrast RHS [17] RHS, psychological diseases and social discrimination. Psychological aspects and social discrimination can have a great impact in determining the choice to forgo health care.…”