Social inequalities and COVID-19 mortality between neighborhoods of Bariloche city, Argentina.

Humans Cities Argentina / epidemiology Bayes Theorem Pandemics COVID-19 Socioeconomic Factors Mortality

COVID-19 Small areas Social inequalities Spatial analysis Urban health

Journal

International journal for equity in health

ISSN: 1475-9276

Titre abrégé: Int J Equity Health

Pays: England

ID NLM: 101147692

Informations de publication

Date de publication:
28 Sep 2023

Historique:

received: 06 03 2023

accepted: 19 09 2023

medline: 23 11 2023

pubmed: 29 9 2023

entrez: 28 9 2023

Statut: epublish

Résumé

The COVID-19 pandemic has shown how intraurban inequalities are likely to reinforce health and social inequalities. Studies at small area level help to visualize social inequialities hidden in large areas as cities or regions. To describe the spatial patterning of COVID-19 death rates in neighborhoods of the medium-sized city of Bariloche, Argentina, and to explore its relationship with the socioeconomic characteristics of neighborhoods. We conducted an ecological study in Bariloche, Argentina. The outcome was counts of COVID-19 deaths between June 2020 and May 2022 obtained from the surveillance system and georeferenced to neighborhoods. We estimated crude- and age-adjusted death rates by neighborhood using a Bayesian approach through a Poisson regression that accounts for spatial-autocorrelation via Conditional Autoregressive (CAR) structure. We also analyzed associations of age-adjusted death rates with area-level socioeconomic indicators. Median COVID-19 death rate across neighborhoods was 17.9 (10th/90th percentile of 6.3/35.2) per 10,000 inhabitants. We found lower age-adjusted rates in the city core and western part of the city. The age-adjusted death rate in the most deprived areas was almost double than in the least deprived areas, with an education-related relative index of inequality (RII) of 2.14 (95% CI 1.55 to 2.96). We found spatial heterogeneity and intraurban variability in age-adjusted COVID-19 death rates, with a clear social gradient, and a higher burden in already deprived areas. This highlights the importance of studying inequalities in health outcomes across small areas to inform placed-based interventions.

Sections du résumé

BACKGROUND BACKGROUND

AIM OBJECTIVE

To describe the spatial patterning of COVID-19 death rates in neighborhoods of the medium-sized city of Bariloche, Argentina, and to explore its relationship with the socioeconomic characteristics of neighborhoods.

METHODS METHODS

We conducted an ecological study in Bariloche, Argentina. The outcome was counts of COVID-19 deaths between June 2020 and May 2022 obtained from the surveillance system and georeferenced to neighborhoods. We estimated crude- and age-adjusted death rates by neighborhood using a Bayesian approach through a Poisson regression that accounts for spatial-autocorrelation via Conditional Autoregressive (CAR) structure. We also analyzed associations of age-adjusted death rates with area-level socioeconomic indicators.

RESULTS RESULTS

Median COVID-19 death rate across neighborhoods was 17.9 (10th/90th percentile of 6.3/35.2) per 10,000 inhabitants. We found lower age-adjusted rates in the city core and western part of the city. The age-adjusted death rate in the most deprived areas was almost double than in the least deprived areas, with an education-related relative index of inequality (RII) of 2.14 (95% CI 1.55 to 2.96).

CONCLUSION CONCLUSIONS

We found spatial heterogeneity and intraurban variability in age-adjusted COVID-19 death rates, with a clear social gradient, and a higher burden in already deprived areas. This highlights the importance of studying inequalities in health outcomes across small areas to inform placed-based interventions.

Identifiants

DOI: 10.1186/s12939-023-02019-w PMID: 37770868 PMC: PMC10537962

pubmed: 37770868

doi: 10.1186/s12939-023-02019-w

pii: 10.1186/s12939-023-02019-w

pmc: PMC10537962

doi:

Types de publication

Journal Article

Langues

eng