Inequality, public health, and COVID-19: an analysis of the Spanish case by municipalities

Abstract

The main objective of this work is to analyze whether inequality in income distribution has an effect on COVID-19 incidence and mortality rates during the first wave of the pandemic, and how the public health system mitigates these effects. To this end, the case of 819 Spanish municipalities is used, and a linear cross-sectional model is estimated. The results obtained allow us to conclude that a higher level of income inequality generates a higher rate of infections but not deaths, highlighting the importance of the Spanish National Health Service, which does not distinguish by income level. Likewise, early detection of infection measured by the number of primary care centers per 100,000 inhabitants, access to health care for the treatment of the most severe cases, unemployment as a proxy for job insecurity, climatic conditions, and population density are also important factors that determine how COVID-19 affects the population.

Municipal Ethnic Composition and Disparities in COVID-19 Infections in New Jersey: A Blinder–Oaxaca Decomposition Analysis

“…We assigned variables to either vulnerability or exposure categories based on the prior literature and our own discussions of how and when these factors affect the exposure to and severity of COVID-19 infection. Furthermore, the exposure and vulnerability factors were calculated at the municipal level, which is consistent with findings from prior studies wherein both differential exposure and vulnerability factors were more prevalent in areas with higher proportions of Black and Latinx residents and were associated with a greater risk of COVID-19 infection and related death [ 20 , 23 , 41 , 46 ].…”

“…Risk factors were selected for inclusion in the model based on theoretical and methodological considerations. Previous literature on risk factors for COVID-19 motivated the theoretical constraints [ 22 , 23 , 26 , 27 , 32 ]. We then further narrowed our selection of risk factors based on the availability of municipality-level measures or those that could be constructed from census-tract level data.…”

“…One additional study using data from cities and towns in Massachusetts found that during the initial months of the pandemic (through 6 May 2020), a 10% increase in the Black and Latinx population was associated with an increase of 312.3 and 258.2 COVID-19 cases per 1,000,000, respectively [ 22 ]. To the best of our knowledge, this study is the only study to have used statewide municipal-level data in the U.S. to examine ethnic disparities in COVID-19, with most research using the municipal unit of analysis conducted in other countries [ 20 , 23 , 24 , 25 , 26 , 27 , 28 ].…”

COVID-19 mortality and deprivation: pandemic, syndemic, and endemic health inequalities

“…Three studies 126 , 127 , 128 showed high mortality rates regardless of deprivation and one of these studies 127 noted that mortality rates shifted back and forth between deprived and affluent areas over time. Four studies 129 , 130 , 131 , 132 showed no association between markers of economic disadvantage and COVID-19 mortality; however, two of these studies 129 , 130 found higher rates among areas with high minority ethnic populations than in areas with low ethnic minority populations, one study found a substantial relationship between COVID-19 case fatalities and poverty, 131 and one found greater area income inequality was associated with higher infections but not deaths. 132 Two studies 133 , 134 showed higher COVID-19 mortality rates in more advantaged areas.…”

“…Two studies from Spain, 133 , 134 however, showed that COVID-19 mortality was associated with socioeconomic advantage and one showed increased area-level income inequality was associated with high infections but not deaths. 132 For example, Garcia 134 examined COVID-19 mortality rates across the 17 autonomous communities of Spain up to May 23, 2020, and found that a 1% increase in the gross domestic product per capita was associated with a 3·1% increase in COVID-19 mortality. One study from Sweden 123 found no significant association between COVID-19 mortality and area-level income or education.…”