Deprivation effect on COVID-19 cases incidence and severity: a geo-epidemiological study in PACA region, France (preprint)

IntroductionThe spread of the COVID-19 pandemic, and its severity, is spatially heterogenous. At the individual level, the socioeconomic status (SES) profile is known to be associated with COVID-19 incidence and severity. The aim of this geo epidemiological study was to investigate the link between SES profile and potential confounders, and COVID-19 incidence and hospitalization rates, at a fine geographical scale. MethodsWe analyzed COVID-19 incidence and severity during two epidemic waves between September 2020 and June 2021, in Provence Alpes Cotes dAzur, a 5 million inhabitants French region. The region is divided into sub-municipal areas that we have classified according to their SES profile. We then conducted a spatial analysis of COVID-19 indicators depending on SES profile, age structure, and health services provision. This analysis considered spatial autocorrelation between areas. ResultsCOVID-19 incidence rates in more deprived areas were similar to those in wealthiest ones. Hospitalization rates of COVID-19 cases in conventional care units were greater in more deprived vs wealthiest areas: Standardized Incidence Ratio (SIR) were respectively 1.34 [95% confidence interval 1.18 - 1.52] and 1.25 [1.13 - 1.38] depending on the epidemic wave. This gap was even greater regarding hospitalization rates of cases in critical care units: SIR = 1.64 [1.30 - 2.07] then 1.33 [1.14 - 1.55] depending on the epidemic wave. Hospitalization rates of COVID-19 cases in conventional care units were also greater in areas with high proportion of elderly people vs young people: SIR respectively 1.24 [1.11 - 1.38] and 1.22 [1.13 - 1.32] depending on the wave. ConclusionConsidering age structure and health services provision, a deprived SES profile is associated to a greater COVID-19 severity in terms of hospitals admissions, in conventional care units and in critical care units. This result implies targeting risk prevention efforts on these areas in pandemic situations, and highlights the need to develop access to healthcare to deprived populations in anticipation of periods of crisis. Key messagesWhat is already known on this topic - Socioeconomic status is associated to COVID-19 incidence and severity, at an individual scale or at a large spatial scale. What this study adds - We showed the positive relationship between deprivation and COVID-19 incidence and hospitalization rates at a fine sub-municipal geographical scale. We considered confusion factors like demographic structure and health services provision. How this study might affect research, practice or policy - These findings may help predict at a fine scale where the impact will be most severe in pandemic situations and make it possible to target risk prevention efforts on these areas.

Drivers and prevalence of COVID-19 vaccine uptake among homeless and precariously housed people in France: a cross-sectional population-based study (preprint)

Background Few global data exist regarding COVID-19 vaccine coverage in people experiencing homelessness (PEH) or precariously housed (PH) who are at high risk for COVID-19 infection, hospitalization, and death. Given the absence of documented French data, we aimed to determine COVID-19 vaccine coverage in PEH/PH in France, and its drivers. Methods We carried out a cross-sectional study following a two-stage cluster-sampling design in Ile-de-France and Marseille, France, in late 2021. Participants aged over 18 years were recruited where they slept the previous night and then stratified for analysis into three housing groups (Streets, Accommodated, and Housed). Interviews were conducted face-to-face in the participant's preferred language. Multilevel univariate and multivariable logistic regression models were built. Findings 3,690 individuals were surveyed: 855 in the Housed stratum, 2,321 in the Accommodated stratum and 514 in the Streets stratum. 76.2% (95%CI 74.3-78.1) reported receiving at least one COVID-19 vaccine dose. Vaccine uptake varied by stratum, with uptake highest (85.6%; reference) in Housed, followed by Accommodated (75.4%; AOR=0.79; 95%CI 0.51-1.09 vs Housed) and lowest in Streets (42.0%; AOR=0.38; 95%CI 0.25-0.57 vs Housed). Use for vaccine certificate, socioeconomic drivers, and vaccine hesitancy explained vaccine coverage. Interpretation In France, PEH/PH are less likely than the general population likely to receive COVID-19 vaccines; with the most excluded being the least likely. The influence of both structural drivers and vaccine beliefs in PEH/PH reinforce the importance of targeted outreach, on-site vaccination and sensitisation activities to further vaccine uptake. Funding Sante Publique France, Agence Nationale de Recherches sur le Sida/Capnet, Agence Regionale de Sante-Ile de France, Medecins Sans Frontieres, and Societe de Pathologie Infectieuse de Langue Francaise.

Children's Mental and Behavioral Health, Schooling, Sociodemographic and Socioeconomic Characteristics During School Closure in France Due To COVID-19: The SAPRIS Project. (preprint)

Background: COVID-19 limitation strategies have led to widespread school closures around the world. The present study reports children’s mental health and associated factors during the COVID-19 school closure in France in the spring of 2020. Methods: We conducted a cross-sectional analysis using data from the SAPRIS project set up during the COVID-19 pandemic in France. Using multinomial logistic regression models, we estimated associations between children’s mental health, children’s health behaviors, schooling, and sociodemographic and socioeconomic characteristics of the children’s families. Results: The sample consisted of 5702 children aged 8 to 9 years, including 50.2% girls. In multivariate logistic regression models, children’s sleeping difficulties were associated with children’s abnormal hyperactivity-inattention (adjusted Odds Ratio (aOR) 2.05; 95% Confidence Interval 1.70-2.47) and emotional symptoms (aOR 5.34; 95% CI 4.16-6.86). Factors specifically associated with abnormal hyperactivity/inattention were: male sex (aOR 2.29; 95% CI 1.90-2.76), access to specialized care prior to the pandemic and its suspension during school closure (aOR 1.51; 95% CI 1.21-1.88), abnormal emotional symptoms (aOR 4.06; 95% CI 3.11-5.29), being unschooled or schooled with assistance before lockdown (aOR 2.13; 95% CI 1.43-3.17), and tutoring with difficulties or absence of a tutor (aOR 3.25; 95% CI 2.64-3.99; aOR 2.47; 95% CI 1.48-4.11, respectively). Factors associated with children’s emotional symptoms were the following: being born pre-term (aOR 1.34; 95% CI 1.03-1.73), COVID-19 cases among household members (aOR 1.72; 95% CI 1.08-2.73), abnormal symptoms of hyperactivity/inattention (aOR 4.18; 95% CI 3.27-5.34) and modest income (aOR 1.45; 95% CI 1.07-1.96; aOR 1.36; 95% CI 1.01-1.84). Conclusions: Multiple characteristics were associated with elevated levels of symptoms of hyperactivity-inattention and emotional symptoms in children during the period of school closure due to COVID-19. Further studies are needed to help policymakers to balance the pros and cons of closing schools, taking into consideration the educational and psychological consequences for children.