Abstract
Evidence on social determinants of health on the risk of SARS-CoV-2 infection and adverse outcomes is still limited. Therefore, this work investigates educational disparities in the incidence of infection and mortality within 30 days of the onset of infection during 2020 in Rome, with particular attention to changes in socioeconomic inequalities over time. A cohort of 1,538,231 residents in Rome on 1 January 2020, aged 35+, followed from 1 March to 31 December 2020, were considered. Cumulative incidence and mortality rates by education were estimated. Multivariable log-binomial and Cox regression models were used to investigate educational disparities in the incidence of SARS-CoV-2 infection and mortality during the entire study period and in three phases of the pandemic. During 2020, there were 47,736 incident cases and 2281 deaths. The association between education and the incidence of infection changed over time. Till May 2020, low- and medium-educated individuals had a lower risk of infection than that of the highly educated. However, there was no evidence of an association between education and the incidence of SARS-CoV-2 infection during the summer. Lastly, low-educated adults had a 25% higher risk of infection from September to December than that of the highly educated. Similarly, there was substantial evidence of educational inequalities in mortality within 30 days of the onset of infection in the last term of 2020. In Rome, social inequalities in COVID-19 appeared in the last term of 2020, and they strengthen the need for monitoring inequalities emerging from this pandemic.
Highlights
The novel coronavirus severe acute respiratory syndrome (SARS-CoV-2) causing coronavirus disease 2019 (COVID-19) appeared in late 2019 in Wuhan, China and rapidly spread progressively on a global scale, with the WHO declaring it a public health emergency of international concern [1]
The crude cumulative incidence in the entire period was 31.0‰ and was higher for low and medium compared to high educational qualifications
The results of this study showed socioeconomic inequalities in both incidence and mortality within 30 days from infection, confirming international results [10,13,14,23]
Summary
The novel coronavirus severe acute respiratory syndrome (SARS-CoV-2) causing coronavirus disease 2019 (COVID-19) appeared in late 2019 in Wuhan, China and rapidly spread progressively on a global scale, with the WHO declaring it a public health emergency of international concern [1]. The most socially disadvantaged people potentially present a higher risk of infection They have limited ability to practice effective physical distancing, have poor housing conditions, and they are at higher risk of worse complications and outcomes because of underlying social, age-related, and clinical vulnerabilities [4]. They may suffer more from the indirect effects of the pandemic as the reorganization of the health care system and the consequent reduction of planned services, including those involving chronic conditions whose burden is socially patterned [5]. Socioeconomic inequalities in the incidence of SARSCoV-2 infection were reported in the United States [9,10], Spain [11,12], and Chile [13]
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