Socioeconomic status determines COVID-19 incidence and related mortality in Santiago, Chile.

Gonzalo E Mena,Pablo A Marquet,Caroline O Buckee,Mauricio Santillana,Pamela P Martinez,Ayesha S Mahmud

doi:10.1126/science.abg5298

Abstract

The COVID-19 pandemic has affected cities particularly hard. Here, we provide an in-depth characterization of disease incidence and mortality and their dependence on demographic and socioeconomic strata in Santiago, a highly segregated city and the capital of Chile. Our analyses show a strong association between socioeconomic status and both COVID-19 outcomes and public health capacity. People living in municipalities with low socioeconomic status did not reduce their mobility during lockdowns as much as those in more affluent municipalities. Testing volumes may have been insufficient early in the pandemic in those places, and both test positivity rates and testing delays were much higher. We find a strong association between socioeconomic status and mortality, measured by either COVID-19-attributed deaths or excess deaths. Finally, we show that infection fatality rates in young people are higher in low-income municipalities. Together, these results highlight the critical consequences of socioeconomic inequalities on health outcomes.

Highlights

We analyzed incidence and mortality attributed to SARS-CoV-2 infection and its association with demographic and socioeconomic status across the urban metropolitan area of the capital of Chile, known as ‘Greater Santiago’
In order to understand the true burden of COVID-19, it is critical to consider demographic and socioeconomic factors and their consequences for the public health response
Our results align with the recent literature on uneven health risks globally, which has highlighted how socially and economically deprived populations are more vulnerable to the burden of epidemics [24, 25]

Summary

Introduction

We analyzed incidence and mortality attributed to SARS-CoV-2 infection and its association with demographic and socioeconomic status across the urban metropolitan area of the capital of Chile, known as ‘Greater Santiago’. An early peak of reported cases was only observed in high SES municipalities during middle March (Fig. 2C), despite the fact that several COVID-19 deaths, which are lagged with respect to infection by up to several weeks, were reported in low SES municipalities during the same period. These findings suggest that an early first wave of infections occurred during March and quickly spread through the rest of the city without being captured by the official counts. Our RmMAP estimates at the municipality level support this claim, as they capture a high volume of early infections in most municipalities (Fig. 2E), a scenario that largely deviates from the official tallies (Fig. 2C)

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