Higher COVID-19 mortality in low-income communities in the City of Cape Town - a descriptive ecological study.

Mary-Ann Davies,Erna Morden,Masudah Paleker,Muzzammil Ismail,Nesbert Zinyakatira,Leslie London,Andrew Boulle,Jamy-Lee Bam,Hannah Hussey

doi:10.12688/gatesopenres.13288.1

Mary-Ann Davies, Erna Morden + Show 7 more

Open Access

https://doi.org/10.12688/gatesopenres.13288.1

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Abstract

Background Cape Town, a South African city with high levels of economic inequality, has gone through two COVID-19 waves. There is evidence globally that low-income communities experience higher levels of morbidity and mortality during the pandemic. Methods Age-standardized COVID-19 mortality in the eight sub-districts of Cape Town was compared by economic indicators taken from the most recent Census (unemployment rate, monthly income). Results The overall Standardized Death Rate (SDR) for COVID-19 in Cape Town was 1 640 per million, but there was wide variation across the different sub-districts. A linear relationship was seen between sub-districts with high poverty and high COVID-19 SDRs. Conclusions Low-income communities in Cape Town experienced higher levels of COVID-19 mortality. As we continue to contend with COVID-19, these communities need to be prioritized for access to quality health care.

Highlights

South Africa is the most unequal country in the world, with a Gini Coefficient of 0.631,2, and within its cities the same inequities prevail
Age-standardized COVID-19 mortality in the eight sub-districts of Cape Town was compared by economic indicators taken from the most recent Census
A linear relationship was seen between subdistricts with high poverty and high COVID-19 Standardized Death Rate (SDR)

Summary

Introduction

South Africa is the most unequal country in the world, with a Gini Coefficient of 0.631,2, and within its cities the same inequities prevail. Post-apartheid Cape Town is a highly divided and unequal city, with socio-economic characteristics still differing along geographic lines[3]. In 2016, the city’s population was 4 232 276 and the Gini coefficient was 0.614. Since SARS-CoV-2 reached Cape Town in March 2020, the city has experienced two waves of COVID-19. Data from the United States (USA) has shown that low socioeconomic status, and race as its proxy, were significantly associated with COVID-19 incidence and mortality[7]. Data from Brazil and Mexico further support the idea that the poorest population groups have lower survival from COVID-199,10. A South African city with high levels of economic inequality, has gone through two COVID-19 waves. There is evidence globally that low-income communities experience higher levels of morbidity and mortality during the pandemic. version 1

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