Social inequalities and dynamics of the early COVID-19 epidemic: a prospective cohort study in France

Abstract

ObjectiveAlthough social inequalities in COVID-19 mortality by race, gender and socioeconomic status are well documented, less is known about social disparities in infection rates and their shift over time. We aim to study the evolution of social disparities in infection at the early stage of the epidemic in France with regard to the policies implemented.DesignRandom population-based prospective cohort.SettingFrom May to June 2020 in France.ParticipantsAdults included in the Epidémiologie et Conditions de Vie cohort (n=77 588).Main outcome measuresSelf-reported anosmia and/or ageusia in three categories: no symptom, during the first epidemic peak (in March 2020) or thereafter (during lockdown).ResultsIn all, 2052 participants (1.53%) reported anosmia/ageusia. The social distribution of exposure factors (density of place of residence, overcrowded housing and working outside the home) was described. Multinomial regressions were used to identify changes in social variables (gender, class and race) associated with symptoms of anosmia/ageusia. Women were more likely to report symptoms during the peak and after. Racialised minorities accumulated more exposure risk factors than the mainstream population and were at higher risk of anosmia/ageusia during the peak and after. By contrast, senior executive professionals were the least exposed to the virus with the lower rate of working outside the home during lockdown. They were more affected than lower social classes at the peak of the epidemic, but this effect disappeared after the peak.ConclusionThe shift in the social profile of the epidemic was related to a shift in exposure factors under the implementation of a stringent stay-at-home order. Our study shows the importance to consider in a dynamic way the gender, socioeconomic and race direct and indirect effects of the COVID-19 pandemic, notably to implement policies that do not widen health inequalities.

When Lack of Trust in the Government and in Scientists Reinforces Social Inequalities in Vaccination Against COVID-19

“…In this respect, it is surprising to note that significant differences were recorded according to income level in the multivariate model, despite vaccination being free in France. While the poorest have the same tendency as others to comply with the use of masks in France ( 42 ), they are less likely to be vaccinated. The exclusion of the poorest part of the population from the social contract could lead to a diminished sensitivity toward the national solidarity dimension of vaccination, strongly emphasized in the public discourse on prevention in France.…”

When mistrust in the government and scientists reinforce social inequalities in vaccination against Covid-19

“…In this respect, it is surprising to note that here significant differences were recorded according to income level in the multivariate model, despite vaccination being free in France. While the poorest people have the same tendency as others to comply with the use of masks in France, [41] they are less likely to be vaccinated. One might think that the level of income here reflects above all a certain degree of social integration.…”

Socio-Demographic Composition and Potential Occupational Exposure to SARS-CoV2 under Routine Working Conditions among Key Workers in France

“…Further studies are needed to capture the real-time dynamics of work-related SARS-CoV-2 exposure among different socio-occupational categories throughout the COVID-19 pandemic. Particularly, other exposure mechanisms, such as housing conditions, commuting modes and duration, and living in a densely populated area need to be taken into account to capture the mechanisms by which social inequalities unfolded [20]. Other groups of workers, such as educational and social work staff who were added to the list of key workers after the first lockdown and who have been shown to be at a high risk of exposure to SARS-CoV-2 in their work should also be considered in the further analysis [35,36].…”

“…Our study builds upon pre-COVID-19 employment survey data to provide insight into the social disparities between different subgroups of 'key workers', by describing their socio-demographic profile and assessing their potential occupational exposure to SARS-CoV-2, and by extension, to infectious diseases of respiratory origin. We hypothesize that minimal distinctions should be made, notably between hospital-healthcare workers, non-hospital healthcare workers, and other key workers outside of healthcare to better understand the social gradient of COVID-19 that was observed in the early pandemic at the intersection of gender, class, and race/ethnicity [12,15,20].…”