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

IntroductionThe 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. MethodsWe analyzed COVID-19 incidence and severity during two epidemic waves between September 2020 and June 2021, in Provence Alpes Cotes dAzur, 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. ResultsCOVID-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. ConclusionConsidering 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. Key messagesWhat is already known on this topic - Socioeconomic status is associated to COVID-19 incidence and severity, at an individual scale or at a large spatial scale. What this study adds - We showed the positive relationship between deprivation and COVID-19 incidence and hospitalization rates at a fine sub-municipal geographical scale. We considered confusion factors like demographic structure and health services provision. How this study might affect research, practice or policy - These findings may help predict at a fine scale where the impact will be most severe in pandemic situations and make it possible to target risk prevention efforts on these areas.