Abstract
ObjectiveArea-level socioeconomic status (SES) is associated with coronavirus disease 2019 (COVID-19) incidence. However, the underlying mechanism of the association is context-specific, and the choice of measure is still important. We aimed to evaluate the socioeconomic gradient regarding COVID-19 incidence in Korea based on several area-level SES measures.MethodsCOVID-19 incidence and area-level SES measures across 229 Korean municipalities were derived from various administrative regional data collected between 2015 and 2020. The Bayesian negative binomial model with a spatial autocorrelation term was used to estimate the incidence rate ratio (IRR) and relative index of inequality (RII) of each SES factor, with adjustment for covariates. The magnitude of association was compared between two epidemic phases: a low phase (<100 daily cases, from May 6 to August 14, 2020) and a rebound phase (>100 daily cases, from August 15 to December 31, 2020).ResultsArea-level socioeconomic inequalities in COVID-19 incidence between the most disadvantaged region and the least disadvantaged region were observed for nonemployment rates [RII = 1.40, 95% credible interval (Crl) = 1.01–1.95] and basic livelihood security recipients (RII = 2.66, 95% Crl = 1.12–5.97), but were not observed for other measures in the low phase. However, the magnitude of the inequalities of these SES variables diminished in the rebound phase. A higher area-level mobility showed a higher risk of COVID-19 incidence in both the low (IRR = 1.67, 95% Crl = 1.26–2.17) and rebound phases (IRR = 1.28, 95% Crl = 1.14–1.44). When SES and mobility measures were simultaneously adjusted, the association of SES with COVID-19 incidence remained significant but only in the low phase, indicating they were mutually independent in the low phase.ConclusionThe level of basic livelihood benefit recipients and nonemployment rate showed social stratification of COVID-19 incidence in Korea. Explanation of area-level inequalities in COVID-19 incidence may not be derived only from mobility differences in Korea but, instead, from the country's own context.
Highlights
Since the first case, reported in December 2019 in China, the severe acute respiratory syndrome coronavirus-2 (SARSCoV2; COVID-19) pandemic has caused unprecedented global challenges due to rapid interpersonal transmission
In Korea, since the first case of COVID-19 in a person who visited China was identified on January 20, 2020, multiple clustered outbreaks associated with religious followings, call centers, and courier services led to a surge in the number of disease occurrences; this was followed by enhanced strict counteractive measures, including social distancing, that were enforced by health authorities, which reduced the weekly average number of cases to single digits [4]
This indicates that underlying socioeconomic gradients are strongly associated with the distribution of incidence and fatality rates of COVID-19, due to variations in personal hygiene, access to testing and treatment, compliance level with social distancing policy, and the ability to work remotely [8]
Summary
Since the first case, reported in December 2019 in China, the severe acute respiratory syndrome coronavirus-2 (SARSCoV2; COVID-19) pandemic has caused unprecedented global challenges due to rapid interpersonal transmission. This virus causes symptoms ranging from mild, such as sore throat and fever, to severe pneumonia resulting in death [1]. In recent studies on COVID-19, historic evidence showed that socioeconomically vulnerable individuals were more likely to have higher incidence and case-fatality rates of COVID-19 [6, 7] This indicates that underlying socioeconomic gradients are strongly associated with the distribution of incidence and fatality rates of COVID-19, due to variations in personal hygiene, access to testing and treatment, compliance level with social distancing policy, and the ability to work remotely [8]. In recent studies regarding COVID-19 in the United States, low-income individuals were less able to reduce their mobility or maintain social distancing, indicating that economic activity is highly associated with behavioral responses to social distancing policy [9, 10]
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