The impact of health inequity on regional variation of COVID-19 transmission in England

Abstract

Considerable spatial heterogeneity has been observed in COVID-19 transmission across administrative regions of England throughout the pandemic. This study investigates what drives these differences. We constructed a probabilistic case count model for 306 administrative regions of England across 95 weeks, fit using a Bayesian evidence synthesis framework. We include the mechanistic impact of acquired immunity, of spatial exportation of cases, and 16 spatially-varying socio-economic, socio-demographic, health, and mobility variables. Model comparison assesses the relative contributions of these respective mechanisms. We find that regionally-varying and time-varying differences in week-to-week transmission were definitively associated with differences in: time spent at home, variant-of-concern proportion, and adult social care funding. However, model comparison demonstrates that the mechanistic impact of these terms was of negligible impact compared to the role of spatial exportation between regions. While these results confirm the impact of some, but not all, measures of regional inequity in England, our work corroborates the finding that observed differences in regional disease transmission during the pandemic were predominantly driven by underlying epidemiological factors rather than the demography and health inequity between regions.