Effects of socio-economic factors on elementary school student COVID-19 infections in Ontario, Canada

BackgroundThe prevalence of SARS-CoV-2 infections in Ontario is disproportionately concentrated in areas with lower-income and racialized groups. We examined whether school-level and area-level socio-economic factors were associated with elementary school student infections in Ontario. MethodsWe performed multi-level modeling analyses using data from the Ministry of Education on school-based infections in Ontario in the 2020-21 school year and on school-level demographics, the Ontario Marginalization Index, and census data to estimate the variability of the cumulative incidence of SARS-CoV-2 infections amongst elementary school students attributable to individual schools (school level, Level 1) and forward sortation areas (FSAs) of schools (area level, Level 2). We explored whether socio-economic factors within individual schools and/or factors common to schools within FSAs predicted the incidence of elementary school student infections. ResultsAt the school level, the proportion of students from low-income households within a school was positively related with the cumulative incidence of SARS-CoV-2 elementary school student infections ({beta} = .083, p < 0.001). At the area level, the dimensions of FSA marginalization were significantly related with cumulative incidence. Ethnic concentration ({beta} = .454, p < 0.001), residential instability ({beta} = .356, p < 0.001), and material deprivation ({beta} = .212, p < 0.001) were positively related. Area-related variables were more likely to explain variance in cumulative incidence than school-related variables (58% versus 1%, respectively). InterpretationSocio-economic characteristics of the geographic location of schools were more important in determining the cumulative incidence of SARS-CoV-2 elementary school student infections than individual school characteristics. Given inequitable effects of protracted education disruption, schools in marginalized areas should be prioritized for infection prevention measures and education continuity and recovery plans.