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CHAMPAIGN, Ill. – People under the age of 40 who live in economically depressed communities in greater Santiago, Chile are three times more likely to die from the effects of the infection than their counterparts in more affluent areas, researchers report in the journal Science. People aged 41 to 80 in communities with low socioeconomic status also suffered more from the pandemic than their peers in more affluent areas, the team found.

The study used new methods to analyze COVID-19 deaths, reported cases, test rates and delays in test results across location, time and age group. The results show striking differences between communities with high and low socioeconomic status and also help explain the factors that contribute to the differences in COVID-19-related infections and mortality in these regions, said Pamela Martinez, professor of microbiology and statistics from the University of Illinois Urbana-Champaign, who co-led the research with Gonzalo Mena, a postdoctoral fellow at the University of Oxford.

The greater Santiago area consists of 34 parishes and is home to nearly 7 million people. The researchers used anonymized cell phone data available through Facebook’s Data for Good initiative to assess residents’ mobility during the pandemic.

“People living in communities with low socioeconomic status did not have as much restricted mobility during the lockdown as those in more affluent communities,” the researchers write. “This supports the hypothesis that people in poorer regions cannot afford to stay at home during the lockdown.”

Access to COVID-19 testing and health services in low-income communities also appears to have contributed to the observed differences in health outcomes, the researchers report.

In the first few weeks of the pandemic, COVID-19 tests were more available to people in affluent parts of the metropolitan area than in poorer places, the researchers found. People in less affluent regions also seem to have waited longer for their test results.

“As public health officials plan their response based on the number of reported infections in a given area, it has resulted in a worse than-needed health care response in areas with lower incomes,” Martinez said. “This has likely contributed to higher death rates in these areas.”

That dynamic changed somewhat a few months after the pandemic started – with testing ramping up in poorer areas through late August, but inequalities in test availability persisted from mid-March through late September, the period under review.

“Greater Santiago recorded more than 70% more deaths between May and July 2020 than in previous years, and places at the lower end of the socio-economic spectrum were hardest hit,” Martinez said.

Access to health care was also less extensive in the economically depressed areas, which also contributed to poorer health outcomes there, the researchers report.

“We found that the southern and western zones of Greater Santiago had four times fewer beds per 10,000 residents and four times fewer people enrolled in the private health care system than the eastern zone, which includes all of the wealthiest communities,” Martinez said. “We also found that more than 90% of deaths attributable to COVID-19 in the South and West Zones occurred in locations other than health facilities.”

In the more affluent Eastern Zone, 55% of COVID-19-related deaths occurred outside of healthcare facilities, she said.

Perhaps most strikingly, the team found that people under 40 in less affluent parts of the region had significantly higher COVID-19-related mortality rates than their peers in more affluent areas.

“In communities with the lowest socio-economic status, the infection death rate was 3.1 times higher for people ages 0 to 40,” Mena said. “Our results show that the socio-economic inequalities we have documented disproportionately affect younger people.”

Understanding how demographic and socioeconomic factors contribute to health outcomes is essential in shaping health care responses, the authors wrote.

“Our findings are consistent with the recent literature on unequal health risks around the world, which has shown how socially and economically disadvantaged populations are more susceptible to the burden of epidemics,” they wrote.

Martinez is also a subsidiary of the Carl R. Woese Institute for Genomic Biology in the United States.

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