Area-level socioeconomic deprivation, non-national residency, and Covid-19 incidence: A longitudinal spatiotemporal analysis in Germany

BACKGROUND: Socioeconomic conditions affect the dynamics of the Covid-19 pandemic. We analysed the association between area-level socioeconomic deprivation, proportion of non-nationals, and incidence of Covid-19 infections in Germany. METHODS: Using linked nationally representative data at the level of 401 German districts from three waves of infection (January-2020 to May-2021), we fitted Bayesian spatiotemporal models to assess the association between socioeconomic deprivation, and proportion of non-nationals with Covid-19 incidence, controlling for age, sex, vaccination coverage, settlement structure, and spatial and temporal effects. We estimated risk ratios (RR) and corresponding 95% credible intervals (95% CrI). We further examined the deprivation domains (education, income, occupation), interactions between deprivation, sex and the proportion of non-nationals, and explored potential pathways from deprivation to Covid-19 incidence. FINDINGS: Covid-19 incidence risk was 15% higher (RR=1·15, 95%-CrI=1·06–1·24) in areas classified with the highest deprivation quintile (Q5) compared to the least deprived areas (Q1). Medium-low (Q2), medium (Q3), and medium-high (Q4) deprived districts showed 6% (1·06, 1·00–1·12), 8% (1·08, 1·01–1·15), and 5% (1·05, 0·98–1·13) higher risk, respectively, compared to the least deprived. Districts with higher proportion of non-nationals showed higher incidence risk compared to districts with lowest proportion, but the association weakened across the three waves. During the first wave, an inverse association was observed with highest incidence risk in least deprived areas (Q1). Deprivation interacted with sex, but not with the proportion of non-nationals. INTERPRETATION: Socioeconomic deprivation, and proportion of non-nationals are independently associated with the incidence of Covid-19. Regional planning of non-pharmaceutical interventions and vaccination strategies would benefit from consideration of area-level deprivation and non-national residency. FUNDING: The study was funded by the German Ministry of Health (ZMV I 1 - 25 20 COR 410).