The Relationship Between Poverty and COVID-19 Infection and Case-Fatality Rates in Germany during the First Wave of the Pandemic

Abstract

The relationship between poverty and the infection and case-fatality rates of COVID-19 has emerged as a controversial but understudied topic. In previous studies and reports from the UK and US evidence emerged that poverty-related indicators had a significant statistical effect on case and mortality rates on district level. For Germany, it has largely been assumed that poverty is an equally relevant factor influencing the transmission rates of the outbreak. This was mostly due to anecdotal evidence from local outbreaks in meat processing plants and reported incidents of infection clusters in poorer city districts. This paper addresses the lack of statistical evidence and investigates thoroughly the link between poverty-related indicators and detected infection and mortality rates of the outbreak using multivariate, multilevel regression while also considering the urban-rural divide of the country. As proxies for poverty the unemployment rate, the per capita presence of general practitioners (physicians), per capita GDP, and the rate of employees with no professional job training is evaluated in relation to the accumulated case and mortality numbers on district level taken from RKI data of June and July 2020. Interestingly, the study finds no general evidence for a poverty-related effect on mortality for German districts during the first wave in the first half of 2020. Furthermore, only employment in low qualification jobs approximated by the job training variable consistently affected case numbers in urban districts in the expected direction.

Spread of COVID-19 in the Russian regions in 2020: factors of excess mortality

“…It is natural that in richer regions with well-developed industry, transport and wholesale trade, the level of business activity is higher and more people continued to work even during the lockdown, therefore both morbidity and mortality were relatively higher. The obtained conclusion contradicts results of many foreign and one Russian work (Khalatbari-Soltani et al 2020;Caul 2020;Ettensperger 2021;Dokhov and Topnikov 2021) but does comply with results of a cross-country study (Chaudhry et al 2020) and studies based on data of the Russian regions (Zemtsov and Baburin 2020;Pilyasov et al 2021).…”

“…Poor areas are characterized by higher population density, making social distancing more difficult. A study based on the German data collected during the first wave of the pandemic proved significance of low-skilled employment as a proxy variable of poverty (Ettensperger 2021).…”

Regional Implications of COVID-19

“…Questions arose regarding the influence of population density, urban-rural divide, and spatial inequalities in healthcare accessibility. The literature indicates that high population density in urban areas, along with disparities in healthcare access between urban and rural regions, and spatial inequalities in healthcare accessibility, play significant roles in facilitating the spread of COVID-19, leading to higher infection rates and poorer health outcomes in certain populations (Boterman 2020; Ettensperger 2021, Roy and Kar 2022).…”