Socioeconomic disparities and concentration of the spread of the COVID-19 pandemic in the province of Quebec, Canada

Abstract

Background Recent studies suggest that the risk of SARS-CoV-2 infection may be greater in more densely populated areas and in cities with a higher proportion of persons who are poor, immigrant, or essential workers. This study examines spatial inequalities in SARS-CoV-2 exposure in a health region of the province of Quebec in Canada. Methods The study was conducted on the 1206 Canadian census dissemination areas in the Capitale-Nationale region of the province of Quebec. The observation period was 21 months (March 2020 to November 2021). The number of cases reported daily in each dissemination area was identified from available administrative databases. The magnitude of inequalities was estimated using Gini and Foster-Greer-Thorbecke (FGT) indices. The association between transmission and socioeconomic deprivation was identified based on the concentration of transmission in socially disadvantaged areas and on nonparametric regressions relating the cumulative incidence rate by area to ecological indicators of spatial disadvantage. Quantification of the association between median family income and degree of exposure of dissemination areas was supplemented by an ordered probit multiple regression model. Results Spatial disparities were elevated (Gini = 0.265; 95% CI [0.251, 0.279]). The spread was more limited in the less densely populated areas of the Quebec City agglomeration and outlying municipalities. The mean cumulative incidence in the subsample made up of the areas most exposed to the pandemic was 0.093. The spread of the epidemic was concentrated in the most disadvantaged areas, especially in the densely populated areas. Socioeconomic inequality appeared early and increased with each successive pandemic wave. The models showed that areas with economically disadvantaged populations were three times more likely to be among the areas at highest risk for COVID-19 (RR = 3.55; 95% CI [2.02, 5.08]). In contrast, areas with a higher income population (fifth quintile) were two times less likely to be among the most exposed areas (RR = 0.52; 95% CI [0.32, 0.72]). Conclusion As with the H1N1 pandemics of 1918 and 2009, the SARS-CoV-2 pandemic revealed social vulnerabilities. Further research is needed to explore the various manifestations of social inequality in relation to the pandemic.

Temporal trends in disparities in COVID-19 seropositivity among Canadian blood donors

“…Regarding neighbourhood characteristics, material deprivation was positively associated with anti-N seropositivity, while social deprivation was negatively associated. This may be because essential workers who cannot work remotely are more likely to live in materially deprived neighbourhoods, 28 and socially deprived neighbourhoods are protected by smaller household sizes. Interestingly, the association between seropositivity and high material deprivation lessened during the more recent Omicron wave, while the association with low social deprivation persisted.…”

Nationwide population-based infection- and vaccine-induced SARS-CoV-2 seroprevalence in Germany at the end of 2021

“…across different demographic groups [25][26][27] , we found that combined seroprevalence differed by age, geographic area and district-level socio-economic deprivation, while infection and basic immunization differed by age and geographic area. The still relatively low infection rate recorded in the overall population is most probably due to the fact that the majority of our data were collected just before the more transmissible Omicron variant became dominant over the Delta variant 28 .…”