Covid-19 mortality not dependent on residential areas

The results of a recently published study show that the risk of dying from Covid-19 was not dependent on the type of area an individual lived in. A new study from Jönköping International Business School (JIBS) at Jönköping University, conducted using extensive microdata from the Swedish Central Bureau of Statistics (SCB) and death registers from the National Board of Health and Welfare, questions the link between Covid-19 mortality and so-called socioeconomically deprived areas in Sweden.

During the Covid-19 pandemic, attention was drawn to socioeconomically deprived areas, often referred to as socially vulnerable, where the mortality from the disease was higher. These areas are often characterized by a relatively high proportion of residents originating from countries other than Sweden, as well as low income and low education levels. Language barriers and lower trust in authorities have been cited as explanations for why these areas may have been particularly vulnerable. However, a new study now shows that individuals in socioeconomically deprived areas did not have a higher likelihood of dying specifically from Covid-19.

During the Covid-19 pandemic, attention was drawn to socioeconomically deprived areas, often referred to as socially vulnerable, where the mortality from the disease was higher. These areas are often characterized by a relatively high proportion of residents originating from countries other than Sweden, as well as low income and education levels. Language barriers and lower trust in authorities have been cited as explanations for why these areas may have been particularly vulnerable. However, a new study now shows that individuals in socioeconomically deprived areas did not have a higher likelihood of dying specifically from Covid-19.

Contrary to the prevailing perception

Using detailed microdata from the Swedish Central Bureau of Statistics (SCB) and a death register from the National Board of Health and Welfare, researchers investigated whether there was a neighborhood effect on Covid-19 deaths. The results indicate that the risk of dying from the disease was not primarily influenced by the residential area a person lived in. Despite previous assumptions, there was no significant increased risk of mortality among individuals in socioeconomically deprived areas when accounting for the baseline risk of mortality.

“How come our findings contradict the prevailing narrative of mortality during the pandemic? There's a crucial reason for this. Our study considers the risk of mortality in general, not just the risk of dying with Covid-19. Our analysis reveals a strong neighborhood effect on the overall likelihood of dying to begin with – just as older individuals had a higher risk of dying even before the pandemic hit. This means that those living in socially deprived residential areas are at a significantly higher risk of dying, regardless of gender, age, ethnic background, education, or family situation," says Sofia Wixe, Assistant Professor of Economics at JIBS, and one of the researchers behind the study.

The researchers found that the overall risk of dying was significantly higher among those living in socioeconomically deprived areas compared to socioeconomically affluent areas. This means that the risk of death (regardless of cause) is not evenly distributed across different areas, which previous analyses of Covid-19 deaths have not adequately considered – and here lies what the researchers refer to as a selection problem.

Individuals from East Africa particularly vulnerable

The study further indicates that what has been perceived as a so-called neighborhood effect on Covid-19 deaths is rather an effect of ethnic background. People of African and Asian descent had a significantly higher likelihood of dying from Covid-19 than those born in Sweden or other parts of Europe, regardless of residential area.

"Individuals from East Africa, in particular, seem to have been especially vulnerable, with an increased likelihood of dying from Covid-19 by 8–9 percentage points compared to those born in Sweden. The potential misinterpretation of this as a neighbourhood effect simply stems from the overrepresentation of individuals with non-European backgrounds in socioeconomically deprived areas," says Charlotta Mellander, Professor of Economics at JIBS.

This overrepresentation of ethnic minorities in socioeconomically deprived areas is partially explained by a phenomenon known in research as spatial sorting, where different population groups tend to "sort" themselves into different types of residential areas, either voluntarily or due to economic constraints, meaning they have limited options in choosing residential areas.

"The Covid-19 pandemic has thus helped illuminate the vulnerability in deprived areas, but perhaps the most important lesson from our study is that the issue is much broader than being linked to a single disease. It requires systematic efforts to improve health conditions in socioeconomically deprived areas, which could also enhance resilience in future pandemics," says Sofia Wixe.

The study, "Evidence of COVID-19 fatalities in Swedish neighborhoods from a full population study," is based on data from 2020. It is authored by JIBS’ researchers Charlotta Mellander and Sofia Wixe, along with José Lobo from Arizona State University, and Luís Bettencourt from the University of Chicago, and published in Scientific Reports. The article can be read in its entirety here: https://www.nature.com/articles/s41598-024-52988-3

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