Impact of the COVID-19 Pandemic on the Socioeconomic Inequalities in Mortality in Spanish Provinces

BackgroundAlthough many studies have assessed the socioeconomic inequalities caused by COVID-19 in several health outcomes, there are numerous issues that have been poorly addressed. For instance, have socioeconomic inequalities in mortality from COVID-19 increased? What impact has the pandemic had on inequalities in specific causes of mortality other than COVID-19? Are the inequalities in COVID-19 mortality different from other causes? In this paper we have attempted to answer these questions for the case of Spain.MethodsWe used a mixed longitudinal ecological design in which we observed mortality from 2005 to 2020 in the 54 provinces into which Spain is divided. We considered mortality from all causes, not excluding, and excluding mortality from COVID-19; and cause-specific mortality. We were interested in analysing the trend of the outcome variables according to inequality, controlling for both observed and unobserved confounders.ResultsOur main finding was that the increased risk of dying in 2020 was greater in the Spanish provinces with greater inequality. In addition, we have found that: (i) the pandemic has exacerbated socioeconomic inequalities in mortality, (ii) COVID-19 has led to gender differences in the variations in risk of dying (higher in the case of women) and (iii) only in cardiovascular diseases and Alzheimer did the increased risk of dying differ between the most and least unequal provinces. The increase in the risk of dying was different by gender (greater in women) for cardiovascular diseases and cancer.ConclusionOur results can be used to help health authorities know where and in which population groups future pandemics will have the greatest impact and, therefore, be able to take appropriate measures to prevent such effects.

Automated summary

The study found that there is a correlation between socioeconomic inequality and COVID-19 mortality in Spain. Provinces with greater socioeconomic inequality had a higher risk of death in 2020. In addition, COVID-19 exacerbated socioeconomic inequalities and showed gender differences in the variations in risk of dying, particularly higher in women. Only in cardiovascular diseases and Alzheimer's disease did the increased risk of dying differ significantly between the most and least unequal provinces. The findings have implications for health authorities to take appropriate measures to address the impact of future pandemics.