Social deprivation and remoteness as determinant of COVID-19 hospitalisations and severity: An area-level analysis in South-Eastern France
Abstract
Background: Since the onset of COVID-19 pandemic, multiple individual-level factors, including socioeconomic determinants, have been associated with infection risk and disease severity. However, public health policies implemented at national level did not consider social determinants at territorial and community levels. In collaboration with the Regional Health Agency of Provence-Alpes-Côte d'Azur (PACA) in France, we analysed COVID-19 hospitalisations together with incidence and testing data, at a fine geographical scale, in order to contextualise the epidemic and assess the impact of area-level socioeconomic and demographic characteristics on disease severity. Methods: We conducted a fine-scale ecological study of COVID-19 hospitalisation rates in the PACA region, during the second and third epidemic waves (September 2020 to June 2021). French census areas (IRIS), the smallest spatial units available for socioeconomic and population-based analysis, were classified into six socio-demographic profiles. We characterised COVID-19 with indicators of incidence and severity relative to total population (incidence and hospitalisation rates) and proportional to tests or cases (proportion of positive tests and proportion of hospitalised cases). Associations between these profiles and COVID-19 indicators were assessed using generalised additive models, adjusting for testing rates, healthcare access, retirement home presence and population age structure. Spatial autocorrelation between areas was accounted for in the models. Results: The most socially deprived IRIS had the highest COVID-19 incidence and hospitalisation rates both in conventional settings and in intensive care units (ICU). Decreasing social deprivation was associated with a gradient of decreasing incidence and hospitalisation rates. Complementary models examining proportion of hospitalisation among confirmed cases indicated that excess hospitalisation in very socially deprived area reflected both higher incidence and greater severity of the disease. IRIS profiles corresponding to remote, rural areas displayed an isolated increase in conventional hospitalisation ratios without a corresponding rise in ICU hospitalisation ratios.
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BibTeX
@article{garneret2026social,
title = {{Social deprivation and remoteness as determinant of COVID-19 hospitalisations and severity: An area-level analysis in South-Eastern France}},
author = {Pierre Garneret and Guillaume Gaubert and Steve Nauleau and Florian Franke and Stanislas Rebaudet and Emilie Mosnier and Luka Canton and Pierre Schalkwijk and Pascal Chaud and Sabira Smaïli and Stéphanie Vandentorren and Michael Huart and Marc-Karim Bendiane and Jordi Landier and Jean Gaudart},
journal = {International Journal of Infectious Diseases},
year = {2026},
month = oct,
doi = {10.1016/j.ijid.2026.109013},
url = {https://hal.science/hal-05801813v1},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Social deprivation and remoteness as determinant of COVID-19 hospitalisations and severity: An area-level analysis in South-Eastern France
AU - Pierre Garneret
AU - Guillaume Gaubert
AU - Steve Nauleau
AU - Florian Franke
AU - Stanislas Rebaudet
AU - Emilie Mosnier
AU - Luka Canton
AU - Pierre Schalkwijk
AU - Pascal Chaud
AU - Sabira Smaïli
AU - Stéphanie Vandentorren
AU - Michael Huart
AU - Marc-Karim Bendiane
AU - Jordi Landier
AU - Jean Gaudart
PY - 2026
DA - 2026/10/15
JO - International Journal of Infectious Diseases
DO - 10.1016/j.ijid.2026.109013
UR - https://hal.science/hal-05801813v1
AB - Background: Since the onset of COVID-19 pandemic, multiple individual-level factors, including socioeconomic determinants, have been associated with infection risk and disease severity. However, public health policies implemented at national level did not consider social determinants at territorial and community levels. In collaboration with the Regional Health Agency of Provence-Alpes-Côte d'Azur (PACA) in France, we analysed COVID-19 hospitalisations together with incidence and testing data, at a fine geographical scale, in order to contextualise the epidemic and assess the impact of area-level socioeconomic and demographic characteristics on disease severity. Methods: We conducted a fine-scale ecological study of COVID-19 hospitalisation rates in the PACA region, during the second and third epidemic waves (September 2020 to June 2021). French census areas (IRIS), the smallest spatial units available for socioeconomic and population-based analysis, were classified into six socio-demographic profiles. We characterised COVID-19 with indicators of incidence and severity relative to total population (incidence and hospitalisation rates) and proportional to tests or cases (proportion of positive tests and proportion of hospitalised cases). Associations between these profiles and COVID-19 indicators were assessed using generalised additive models, adjusting for testing rates, healthcare access, retirement home presence and population age structure. Spatial autocorrelation between areas was accounted for in the models. Results: The most socially deprived IRIS had the highest COVID-19 incidence and hospitalisation rates both in conventional settings and in intensive care units (ICU). Decreasing social deprivation was associated with a gradient of decreasing incidence and hospitalisation rates. Complementary models examining proportion of hospitalisation among confirmed cases indicated that excess hospitalisation in very socially deprived area reflected both higher incidence and greater severity of the disease. IRIS profiles corresponding to remote, rural areas displayed an isolated increase in conventional hospitalisation ratios without a corresponding rise in ICU hospitalisation ratios.
SN - 1201-9712
SN - 1878-3511
ER -