Democracy, Inequality and Covid-19 Pandemic Outcomes: Age-standardised excess mortality and GDP growth in island and non-island jurisdictions

BackgroundWhile democracy typically correlates with superior population health outcomes, and inequality adversely affects population wellbeing, their roles in pandemic performance remain contested, particularly across geographic context and when using methodologically robust metrics. MethodsWe examined associations between liberal democracy (V-Dem Liberal Democracy Index) and income inequality (Gini coefficient) with Covid-19 health and economic outcomes across 193 jurisdictions, stratified by island (n = 48) versus non-island (n = 145) status. Outcomes were age-standardised cumulative excess mortality (2020-2021) and GDP per capita growth (2019-2020, 2020-2021). Ordinary least squares regression models controlled for GDP per capita, population size, Global Health Security Index, and government corruption. ResultsDemocracy predicted reduced excess mortality in islands ({beta} = -5.92 {+/-}2.20 SE, p = 0.013, adjusted R{superscript 2} = 0.37) but not non-islands ({beta} = -0.47 {+/-}0.65 SE, p = 0.47), confirmed by island interaction ({beta} = -4.51 {+/-}1.72, p = 0.0095). Higher inequality predicted increased mortality in non-islands ({beta} = +0.052 {+/-}0.019 SE, p = 0.009, adjusted R{superscript 2} = 0.50) and larger GDP contractions in 2019-2020 ({beta} = -0.242 {+/-}0.053 SE, p = 0.000013, adjusted R{superscript 2} = 0.22), but not in islands. Democracy showed no systematic association with economic trajectories. ConclusionsDemocracys pandemic benefits are geographically contingent, concentrated in island jurisdictions, while inequalitys adverse effects on health and economic outcomes are pervasive in non-island states. Preparedness strategies should account for these contextual dependencies to mitigate the impact of infectious disease and potential future global catastrophic biological risks. Key messagesO_LIThis research aimed to establish the relationship between jurisdiction regime type (level of democracy) as well as level of income inequality and Covid-19 pandemic health and economic outcomes. C_LIO_LIWe found that a higher Gini inequality coefficient predicted greater cumulative excess mortality (2020-2021) and a larger initial economic contraction, while greater democracy predicted lower cumulative excess mortality in islands only. C_LIO_LIThese findings suggest that non-specific factors such as inequality and democracy may drive pandemic outcomes and important policy relevant differences exist across jurisdiction types (island vs non-island). C_LI