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PLoS One . Urban-rural disparities in COVID-19 hospitalisations and mortality: A population-based study on national surveillance data from Germany

tetano

Editor, Senior Moderator
PLoS One


. 2024 May 2;19(5):e0301325.
doi: 10.1371/journal.pone.0301325. eCollection 2024. Urban-rural disparities in COVID-19 hospitalisations and mortality: A population-based study on national surveillance data from Germany and Italy

Simona Bignami-Van Assche[SUP] 1 [/SUP], Federico Ferraccioli[SUP] 2 [/SUP], Nicola Riccetti[SUP] 2 [/SUP], Jaime Gomez-Ramirez[SUP] 2 [/SUP], Daniela Ghio[SUP] 3 [/SUP], Nikolaos I Stilianakis[SUP] 2 4 [/SUP]



Affiliations
Abstract

Purpose: Recent literature has highlighted the overlapping contribution of demographic characteristics and spatial factors to urban-rural disparities in SARS-CoV-2 transmission and outcomes. Yet the interplay between individual characteristics, hospitalisation, and spatial factors for urban-rural disparities in COVID-19 mortality have received limited attention.
Methods: To fill this gap, we use national surveillance data collected by the European Centre for Disease Prevention and Control and we fit a generalized linear model to estimate the association between COVID-19 mortality and the individuals' age, sex, hospitalisation status, population density, share of the population over the age of 60, and pandemic wave across urban, intermediate and rural territories.
Findings: We find that in what type of territory individuals live (urban-intermediate-rural) accounts for a significant difference in their probability of dying given SARS-COV-2 infection. Hospitalisation has a large and positive effect on the probability of dying given SARS-CoV-2 infection, but with a gradient across urban, intermediate and rural territories. For those living in rural areas, the risk of dying is lower than in urban areas but only if hospitalisation was not needed; while for those who were hospitalised in rural areas the risk of dying was higher than in urban areas.
Conclusions: Together with individuals' demographic characteristics (notably age), hospitalisation has the largest effect on urban-rural disparities in COVID-19 mortality net of other individual and regional characteristics, including population density and the share of the population over 60.


 
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