Elsevier

eClinicalMedicine

Volume 49, July 2022, 101485
eClinicalMedicine

Articles
Area-level socioeconomic deprivation, non-national residency, and Covid-19 incidence: A longitudinal spatiotemporal analysis in Germany

https://doi.org/10.1016/j.eclinm.2022.101485Get rights and content
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open access

Summary

Background

Socioeconomic conditions affect the dynamics of the Covid-19 pandemic. We analysed the association between area-level socioeconomic deprivation, proportion of non-nationals, and incidence of Covid-19 infections in Germany.

Methods

Using linked nationally representative data at the level of 401 German districts from three waves of infection (January-2020 to May-2021), we fitted Bayesian spatiotemporal models to assess the association between socioeconomic deprivation, and proportion of non-nationals with Covid-19 incidence, controlling for age, sex, vaccination coverage, settlement structure, and spatial and temporal effects. We estimated risk ratios (RR) and corresponding 95% credible intervals (95% CrI). We further examined the deprivation domains (education, income, occupation), interactions between deprivation, sex and the proportion of non-nationals, and explored potential pathways from deprivation to Covid-19 incidence.

Findings

Covid-19 incidence risk was 15% higher (RR=1·15, 95%-CrI=1·06–1·24) in areas classified with the highest deprivation quintile (Q5) compared to the least deprived areas (Q1). Medium-low (Q2), medium (Q3), and medium-high (Q4) deprived districts showed 6% (1·06, 1·00–1·12), 8% (1·08, 1·01–1·15), and 5% (1·05, 0·98–1·13) higher risk, respectively, compared to the least deprived. Districts with higher proportion of non-nationals showed higher incidence risk compared to districts with lowest proportion, but the association weakened across the three waves. During the first wave, an inverse association was observed with highest incidence risk in least deprived areas (Q1). Deprivation interacted with sex, but not with the proportion of non-nationals.

Interpretation

Socioeconomic deprivation, and proportion of non-nationals are independently associated with the incidence of Covid-19. Regional planning of non-pharmaceutical interventions and vaccination strategies would benefit from consideration of area-level deprivation and non-national residency.

Funding

The study was funded by the German Ministry of Health (ZMV I 1 - 25 20 COR 410).

Keywords

SARS-CoV-2
COVID-19
Bayesian spatiotemporal analysis
Infectious disease modelling
Socioeconomic deprivation
Socioeconomic inequalities
Equity
Migration
Income
Education
Occupation

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