{
  "abstract": "BackgroundPrevious studies indicated that regional fluctuations in COVID-19 impact were associated with socioeconomic, demographic and environmental factors early in the pandemic. It is unclear whether factors associated with regional COVID-19 mortality and SARS-CoV-2 infections changed over the course of the pandemic.\n\nMethodsWe evaluated the association of ecological factors with municipality-specific COVID-19 mortality in the national population of Austria between January 2020 and June 2023. Analyses were conducted separately per calendar year and pooled across years via random-effects meta-analysis. Outcomes were analysed using univariable and multivariable zero-inflated negative binomial (ZINB) regression, including annually averaged environmental exposome exposure (including air pollution and UV radiation), socioeconomic, demographic and infection dissemination predictors with significance threshold set to p<0.005. Secondary analysis modelled SARS-CoV-2 infections using of negative-binomial model (NB). Two additional approaches for smaller predictor set selection were applied as sensitivity analyses.\n\nResultsWithin the entire observation period 18,430 COVID-19 deaths were reported. In univariable analyses (pooled RR (99.5% CI)), COVID-19 mortality was significantly associated with the proportion of commuters (0.79 (0.73-0.86)), residents aged 75-84 (1.18 (1.01-1.37)) and [≥]85 years (1.29 (1.04-1.60)), residents with at most compulsory education (1.15 (1.02-1.29)), employed residents aged 15-64 (0.89 (0.85-0.93)), and homeowners (0.91 (0.83-0.99)), as well as with precipitation (0.94 (0.89-0.99)) and the average time with a mean temperature of 5-15 {degrees}C (0.95 (0.90-0.99)). In multivariable analyses the share of population aged 85 or older (1.30 (1.09-1.54)) and home ownership (0.92 (0.87-0.98)) were independently significant. Mortality predictor estimates were relatively stable across pandemic years. Across 5,963,882 documented SARS-CoV-2 infections share of employed in 15- to 64-year-olds (1.01 (1.01-1.02)), part-time employment rate (1.01 (1.00-1.02)) and district level nursing care allowance recipiency (0.97 (0.95-0.98)) were associated with detected infections. Overnight stays, population 85 or older, income, compulsory education or less and air pollution all had multiple significant estimates with opposite directionality, leading to non-significant overall associations. Sensitivity analyses outcomes mirrored main analyses outcomes.\n\nConclusionsThroughout the pandemic in Austria, demographic and socioeconomic factors were associated with COVID-19 mortality and infections, but many associations, especially for infections, were unstable over time. These findings underscore the importance of structural vulnerabilities in epidemic impact.",
  "abstract_shown": true,
  "affiliations": [
    "Medical University of Graz"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 11,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "U. Riedmann"
    },
    {
      "name": "A. C. Stevenson"
    },
    {
      "name": "C. Dibben"
    },
    {
      "name": "W. B. Grant"
    },
    {
      "name": "M. Sprenger"
    },
    {
      "name": "L. Zgaga"
    },
    {
      "name": "J. Woltsche"
    },
    {
      "name": "P. Wolf"
    },
    {
      "name": "W. Maerz"
    },
    {
      "name": "J. Ioannidis"
    },
    {
      "name": "S. Pilz"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/889k0hd7r5s3r.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.10.15.26365614",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.10.15.26365614v1.full",
  "id": "889k0hd7r5s3r",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.10.15.26365614v1",
  "language": null,
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "epidemiology"
    ],
    [
      "openalex",
      "2611|COVID-19 epidemiological studies"
    ]
  ],
  "openalex": "W7222536010",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.10.15.26365614v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-15",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/889k0hd7r5s3r.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:21:04Z",
      "native_id": "10.64898/2026.10.15.26365614",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.10.15.26365614v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:epidemiology",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Municipality-level ecological analysis of COVID-19 mortality and infections in Austria, 2020 to 2023",
  "title_text": "Municipality-level ecological analysis of COVID-19 mortality and infections in Austria, 2020 to 2023",
  "type": "preprint",
  "updated_at": "2026-10-30T12:21:04Z",
  "url": "https://research.draconitic.com/paper/889k0hd7r5s3r",
  "venue": "medRxiv",
  "versions": []
}