The effect of social deprivation on the dynamic of SARS-CoV-2 infection in France: a population-based analysis.
Journal
The Lancet. Public health
ISSN: 2468-2667
Titre abrégé: Lancet Public Health
Pays: England
ID NLM: 101699003
Informations de publication
Date de publication:
03 2022
03 2022
Historique:
received:
25
11
2021
revised:
28
12
2021
accepted:
07
01
2022
pubmed:
18
2
2022
medline:
15
3
2022
entrez:
17
2
2022
Statut:
ppublish
Résumé
Data on health inequalities related to the dynamic of SARS-CoV-2 infection in France are scarce. The aim of this study was to analyse the association between an area-based deprivation indicator and SARS-CoV-2 incidence, positivity, and testing rates between May 2020 and April 2021. We analysed data reported to the Système d'Information de Dépistage Populationnel surveillance system between May 14, 2020 and April 29, 2021, which records the results of all SARS-CoV-2 tests in France. Residential addresses of tested individuals were geocoded to retrieve the associated aggregated units for the statistical information (IRIS) scale, corresponding to an area comprising 2000 inhabitants relatively homogenous in terms of socioeconomic characteristics. A social deprivation score was assigned to each area using the European Deprivation Index (EDI). We fitted negative binomial generalised additive models to model the age-standardised and sex-standardised ratios for SARS-CoV-2 incidence, positivity rates, and testing rates, and to estimate incidence rate ratios (IRRs) and 95% CIs of their association with EDI quintiles, using the first quintile (least deprived) as the reference category, adjusted for week, population density, and region. Analyses were based on 70 990 478 SARS-CoV-2 tests, of which 5 000 972 were positive. SARS-CoV-2 incidence was higher in the most deprived areas than the least deprived areas (IRR 1·148 [95% CI 1·138-1·158]) and positivity rates were also higher (IRR 1·283 [1·273-1·294]), whereas testing rates were lower in the most deprived areas than the least deprived areas (IRR 0·905 [0·904-0·907]). SARS-CoV-2 incidence and positivity rates remained higher in the most deprived areas than the least deprived areas during the second and third national lockdowns, and variation in testing rate was observed according to population density. Our results highlight a positive social gradient between deprivation and the risk of testing positive for SARS-CoV-2, with the highest risk among individuals living in the most deprived areas and a negative social gradient for testing rate. These findings might reflect structural barriers to health-care access in France and lower capacity of deprived populations to benefit from protective measures. None.
Sections du résumé
BACKGROUND
Data on health inequalities related to the dynamic of SARS-CoV-2 infection in France are scarce. The aim of this study was to analyse the association between an area-based deprivation indicator and SARS-CoV-2 incidence, positivity, and testing rates between May 2020 and April 2021.
METHODS
We analysed data reported to the Système d'Information de Dépistage Populationnel surveillance system between May 14, 2020 and April 29, 2021, which records the results of all SARS-CoV-2 tests in France. Residential addresses of tested individuals were geocoded to retrieve the associated aggregated units for the statistical information (IRIS) scale, corresponding to an area comprising 2000 inhabitants relatively homogenous in terms of socioeconomic characteristics. A social deprivation score was assigned to each area using the European Deprivation Index (EDI). We fitted negative binomial generalised additive models to model the age-standardised and sex-standardised ratios for SARS-CoV-2 incidence, positivity rates, and testing rates, and to estimate incidence rate ratios (IRRs) and 95% CIs of their association with EDI quintiles, using the first quintile (least deprived) as the reference category, adjusted for week, population density, and region.
FINDINGS
Analyses were based on 70 990 478 SARS-CoV-2 tests, of which 5 000 972 were positive. SARS-CoV-2 incidence was higher in the most deprived areas than the least deprived areas (IRR 1·148 [95% CI 1·138-1·158]) and positivity rates were also higher (IRR 1·283 [1·273-1·294]), whereas testing rates were lower in the most deprived areas than the least deprived areas (IRR 0·905 [0·904-0·907]). SARS-CoV-2 incidence and positivity rates remained higher in the most deprived areas than the least deprived areas during the second and third national lockdowns, and variation in testing rate was observed according to population density.
INTERPRETATION
Our results highlight a positive social gradient between deprivation and the risk of testing positive for SARS-CoV-2, with the highest risk among individuals living in the most deprived areas and a negative social gradient for testing rate. These findings might reflect structural barriers to health-care access in France and lower capacity of deprived populations to benefit from protective measures.
FUNDING
None.
Identifiants
pubmed: 35176246
pii: S2468-2667(22)00007-X
doi: 10.1016/S2468-2667(22)00007-X
pmc: PMC8843336
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e240-e249Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of interests We declare no competing interests.
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