Emerging socio-economic disparities in COVID-19-related deaths during the second pandemic wave in Germany

Hoebel, Jens; Michalski, Niels; Diercke, Michaela; Hamouda, Osamah; Wahrendorf, Morten; Dragano, Nico; Nowossadeck, Enno

doi:10.1016/j.ijid.2021.10.037

Cited by 31 publications

(25 citation statements)

References 4 publications

(5 reference statements)

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“…In fact, ecological studies on regional differences of COVID-19 have experienced increased attention during the pandemic [14,15]. For example, studies from Germany [16][17][18][19], the UK [20], and the US [21,22], suggest that SARS-CoV-2 infections risks and COVID-19 mortality rates are comparatively higher in regions with high poverty rates or low income levels, or in regions that are generally socioeconomically disadvantaged. Interestingly, studies that also compare associations between different phases of the pandemic in Germany demonstrate that these socioeconomic differences are less pronounced (or even inversed) in the early rst wave of the pandemic (with lower infection rates and mortality in more disadvantaged regions) [19,23,24].…”

Section: Introductionmentioning

confidence: 99%

Regional disparities in SARS-CoV-2 infections by labour market indicators: a spatial panel analysis using German notification data

Wahrendorf

Reuter

Hoebel

et al. 2022

Preprint

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Background Regional labour markets and their properties are named as potential reasons for regional variations in SARS-CoV-2 infections rates, but empirical evidence is missing. Methods Using notification data on laboratory-confirmed SARS-CoV-2 infections, we calculated weekly age-standardised incidence rates (ASIRs) for working-age populations at the regional level of Germany’s 400 districts. Data covered nearly two years (March 2020 till December 2021), including four main waves of the pandemic. For each of the pandemic waves, we investigated regional differences in weekly ASIRs according to three regional labour market indicators: (1) employment rate, (2) employment by sector, and (3) capacity to work from home. We use spatial panel regression analysis, which incorporates geospatial information and accounts for regional clustering of infections. Results For all four pandemic waves under study, we found that regions with higher proportions of people in employment had higher ASIRs and a steeper increase of infections during the waves. Further, the composition of the workforce mattered: rates were higher in regions with larger secondary sectors or if opportunities of working from home were comparatively low. Associations remained consistent after adjusting for potential confounders, including a proxy measure of regional vaccination progress. Conclusions If further validated by studies using individual-level data, our study calls for increased intervention efforts to improve protective measures at the workplace, particularly among workers of the secondary sector with no opportunities to work from home. It also points to the necessity of strengthening work and employment as essential components of pandemic preparedness plans.

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Section: Introductionmentioning

confidence: 99%

Regional disparities in SARS-CoV-2 infections by labour market indicators: a spatial panel analysis using German notification data

Wahrendorf

Reuter

Hoebel

et al. 2022

Preprint

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“…Again, this pattern reversed as the second wave progressed. In the second wave, COVID-19-related mortality and area deprivation were also examined in Germany, with higher mortality rates found among residents of deprived areas (16). In the third wave of infection, higher incidences were observed in socioeconomically disadvantaged regions (17,18), which was related to the fact that individuals from socioeconomically disadvantaged regions were not able to limit their mobility as much as individuals from less disadvantaged regions due to their occupation (17).…”

Section: Discussionmentioning

confidence: 99%

“…Associations between aspects of COVID-19 and area deprivation have been investigated for several countries, including Germany (10)(11)(12)(13)(14)(15)(16)(17)(18). Even though COVID-19 is transmitted by individuals, these studies consistently report that the risk of COVID-19 infections, as well as COVID-19-related mortality, are higher in more deprived than in less deprived areas.…”

Section: Introductionmentioning

confidence: 99%

Area Deprivation and COVID-19 Incidence and Mortality in Bavaria, Germany: A Bayesian Geographical Analysis

Manz

Schwettmann

Mansmann

et al. 2022

Front. Public Health

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BackgroundArea deprivation has been shown to be associated with various adverse health outcomes including communicable as well as non-communicable diseases. Our objective was to assess potential associations between area deprivation and COVID-19 standardized incidence and mortality ratios in Bavaria over a period of nearly 2 years. Bavaria is the federal state with the highest infection dynamics in Germany and demographically comparable to several other European countries.MethodsIn this retrospective, observational ecological study, we estimated the strength of associations between area deprivation and standardized COVID-19 incidence and mortality ratios (SIR and SMR) in Bavaria, Germany. We used official SARS-CoV-2 reporting data aggregated in monthly periods between March 1, 2020 and December 31, 2021. Area deprivation was assessed using the quintiles of the 2015 version of the Bavarian Index of Multiple Deprivation (BIMD 2015) at district level, analyzing the overall index as well as its single domains.ResultsDeprived districts showed higher SIR and SMR than less deprived districts. Aggregated over the whole period, the SIR increased by 1.04 (95% confidence interval (95% CI): 1.01 to 1.07, p = 0.002), and the SMR by 1.11 (95% CI: 1.07 to 1.16, p < 0.001) per BIMD quintile. This represents a maximum difference of 41% between districts in the most and least deprived quintiles in the SIR and 110% in the SMR. Looking at individual months revealed clear linear association between the BIMD quintiles and the SIR and SMR in the first, second and last quarter of 2021. In the summers of 2020 and 2021, infection activity was low.ConclusionsIn more deprived areas in Bavaria, Germany, higher incidence and mortality ratios were observed during the COVID-19 pandemic with particularly strong associations during infection waves 3 and 4 in 2020/2021. Only high infection levels reveal the effect of risk factors and socioeconomic inequalities. There may be confounding between the highly deprived areas and border regions in the north and east of Bavaria, making the relationship between area deprivation and infection burden more complex. Vaccination appeared to balance incidence and mortality rates between the most and least deprived districts. Vaccination makes an important contribution to health equality.

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“…Socioeconomic inequalities in Covid-19 morbidity and mortality show that less privileged groups are at higher risk for infection, severe course of disease, 1 , 2 , 3 hospitalisation, 2 and death. 4 , 5 Such inequalities have also been shown at the area-level with high socioeconomic deprivation areas being at higher risk for Covid-19 infections, 6 , 7 and patients living in most deprived areas showing higher hospitalization rates, admissions to intensive care units, and mortality. 8 In Germany, Covid-19 incidence was higher in socioeconomically better-off areas during the first wave of infection, while the pattern changed during the second infection wave towards higher incidence in areas with highest socioeconomic deprivation.…”

Section: Introductionmentioning

confidence: 88%

Area-level socioeconomic deprivation, non-national residency, and Covid-19 incidence: A longitudinal spatiotemporal analysis in Germany

2022

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Emerging socio-economic disparities in COVID-19-related deaths during the second pandemic wave in Germany

Cited by 31 publications

References 4 publications

Regional disparities in SARS-CoV-2 infections by labour market indicators: a spatial panel analysis using German notification data

Regional disparities in SARS-CoV-2 infections by labour market indicators: a spatial panel analysis using German notification data

Area Deprivation and COVID-19 Incidence and Mortality in Bavaria, Germany: A Bayesian Geographical Analysis

Area-level socioeconomic deprivation, non-national residency, and Covid-19 incidence: A longitudinal spatiotemporal analysis in Germany

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