COVID-19 and social inequalities: a complex and dynamic interaction
- Bambara C
- Riordan R
- Ford J
- Matthew F
- Wilkins CH
- Friedman CE
- Churchwell AL
- et al.
- Riou J.
- Panczak R
- Althaus CL
- et al.
- MA Green
- García-Fiñana M
- Bar B
- et al.
- Lewis NM
- Frederic M.
- Wagstaff S
- et al.
These inequalities are associated with differential exposure to the virus, greater susceptibility to infection, more frequent comorbidities associated with serious outcomes, and disparate access to care.
- Vandentorren S
- Smaili S
- E Chatignoux
- et al.
investigated the association between an area-based deprivation indicator and SARS-CoV-2 incidence, positivity, and screening rates in France. To our knowledge, this is the first large-scale study exploring the issue of social inequalities relating to COVID-19 screening and the dynamics of the SARS-CoV-2 pandemic in France. The study benefited from the quality and exhaustiveness of the national databases. The authors used data from the Population Screening Information System, which records the results of all SARS-CoV-2 tests in France, for the period from May 2020 to April 2021, during which nearly 71 million SARS-CoV-2 tests have been recorded, including 5,000,972 positive tests. Vandentorren and colleagues showed that SARS-CoV-2 incidence, positivity rates, and testing rates differed in the most socially deprived areas (measured by the European Deprivation Index [EDI]) compared to less deprived areas. A clear social gradient was identified, whereby people living in the most deprived areas had the highest risk of contracting SARS-CoV-2, but a concomitant lower likelihood of being tested. This social gradient was more pronounced in densely populated areas than in sparsely populated areas.
Vandentorren and colleagues analyzed the weekly dynamics of SARS-CoV-2 incidence, positivity rates, and testing rates by deprivation group and population density, which showed that the measures implemented by the French government to manage the pandemic, in particular the confinements, had a differential impact on these results in the most and least deprived areas, and that this impact varied according to population density. In less populated areas, during the second lockdown, SARS-CoV-2 incidence, positivity rates, and testing rates were lower in more deprived areas than in less deprived areas. However, during the third lockdown, incidence and screening rates were higher in the most deprived areas, with a similar positivity rate. In densely populated municipalities, while testing rates were similar across all deprivation quintiles during the second lockdown, they were lower in the most deprived areas than in less deprived areas at the time of the third lockdown.
In this study, some area codes were excluded, so the authors compared the distribution of total number of tests and number of positive results by age and gender between missing and included data. The differences, although statistically significant, were small. It would have been interesting to know how comparable the excluded areas were with respect to other socioeconomic variables, although this question is unlikely to have biased the results. Moreover, the impact of each social variable in the EDI could not be studied, but it could be interesting to deepen it. As socio-economic data were not available at the individual level, the authors used an ecological measure of deprivation at the area level, excluding a detailed study of the mechanisms at work. Further studies are needed to investigate the complex spatio-temporal interactions suggested by the results. Moreover, since access to the COVID-19 vaccine could also be affected by socio-economic inequalities, it would be very interesting to integrate vaccination into the analyses.
- Dubost CL
- Pollak C
- Rey S
In 2013, the French government
have announced their intention to reduce social inequalities in health within the framework of public health law. However, this will require sustained and coordinated multisectoral initiatives, many of which have yet to be developed and implemented. These challenges could explain the results described by Vandentorren and colleagues and the findings of other national reports,
- Dubost CL
- Pollak C
- Rey S
including structural barriers to vaccination. Such studies could be useful for any future strategy aimed at tackling these inequalities.
We declare no competing interests.
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Posted: February 14, 2022
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