Epidemiological characteristics and outcomes of COVID-19 cases: mortality inequalities by socio-economic status, Barcelona, Spain, 24 February to 4 May 2020

Politi, Julieta; Martín Sánchez, Mario; Mercuriali, Lilas; Borras Bermejo, Blanca; López Contreras, Joaquín; Vilella, Anna; Villar García, Judit; COVID-19 Surveillance Working Group of Barcelona; Orcau, Àngels; García de Olalla, Patrícia; Rius, Cristina

doi:http://dx.doi.org/10.2807/1560-7917.ES.2021.26.20.2001138

Epidemiological characteristics and outcomes of COVID-19 cases: mortality inequalities by socio-economic status, Barcelona, Spain, 24 February to 4 May 2020

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Politi J, Martín-Sánchez M, Mercuriali L, Borras-Bermejo B, Lopez-Contreras J, Vilella A, Villar J; COVID-19 Surveillance Working Group of Barcelona, Orcau A, de Olalla PG, Rius C. Epidemiological characteristics and outcomes of COVID-19 cases: mortality inequalities by socio-economic status, Barcelona, Spain, 24 February to 4 May 2020. Euro Surveill. 2021;26(20):2001138. DOI: 10.2807/1560-7917.ES.2021.26.20.2001138

Abstract

Background: Population-based studies characterising outcomes of COVID-19 in European settings are limited, and effects of socio-economic status (SES) on outcomes have not been widely investigated. Aim: We describe the epidemiological characteristics of COVID-19 cases, highlighting incidence and mortality rate differences across SES during the first wave in Barcelona, Catalonia, Spain. Methods: This population-based study reports individual-level data of laboratory-confirmed COVID-19 cases diagnosed from 24 February to 4 May 2020, notified to the Public Health Agency of Barcelona and followed until 15 June 2020. We analysed end-of-study vital status and the effects of chronic conditions on mortality using logistic regression. Geocoded addresses were linked to basic health area SES data, estimated using the composed socio-economic index. We estimated age-standardised incidence, hospitalisation, and mortality rates by SES. Results: Of 15,554 COVID-19-confirmed cases, the majority were women (n = 9,028; 58%), median age was 63 years (interquartile range: 46–83), 8,046 (54%) required hospitalisation, and 2,287 (15%) cases died. Prevalence of chronic conditions varied across SES, and multiple chronic conditions increased risk of death (≥ 3, adjusted odds ratio: 2.3). Age-standardised rates (incidence, hospitalisation, mortality) were highest in the most deprived SES quartile (incidence: 1,011 (95% confidence interval (CI): 975–1,047); hospitalisation: 619 (95% CI: 591–648); mortality: 150 (95% CI: 136–165)) and lowest in the most affluent (incidence: 784 (95% CI: 759–809); hospitalisation: 400 (95% CI: 382–418); mortality: 121 (95% CI: 112–131)). Conclusions: COVID-19 outcomes varied markedly across SES, underscoring the need to implement effective preventive strategies for vulnerable populations.