COVID-19 mortality with regard to healthcare services availability, health risks, and socio-spatial factors at department level in France: A spatial cross-sectional analysis

Abstract

Background The 2019 coronavirus (COVID-19) epidemic began in Wuhan, China in December 2019 and quickly spread to the rest of the world. This study aimed to analyse the associations between the COVID-19 mortality rate in hospitals, the availability of health services, and socio-spatial and health risk factors at department level. Methods and findings This spatial cross-sectional study used cumulative mortality data due to the COVID-19 pandemic in hospitals until 30 November 2020 as a main outcome, across 96 departments of mainland France. Data concerning health services, health risk factors, and socio-spatial factors were used as independent variables. Independently, we performed negative binomial, spatial and geographically weighted regression models. Our results revealed substantial geographic disparities. The spatial exploratory analysis showed a global positive spatial autocorrelation in each wave indicating a spatial dependence of the COVID-19 deaths across departments. In first wave about 75% of COVID-19 deaths were concentrated in departments of five regions compared to a total of 13 regions. The COVID-19 mortality rate was associated with the physicians density, and not the number of resuscitation beds. Socio-spatial factors were only associated with the COVID-19 mortality rate in first wave compared to wave 2. For example, the COVID-19 mortality rate increased by 35.69% for departments densely populated. Health risk factors were associated with the COVID-19 mortality rate depending on each wave. This study had inherent limitations to the ecological analysis as ecological bias risks and lack of individual data. Conclusions Our results suggest that the COVID-19 pandemic has spread more rapidly and takes more severe forms in environments where there is already a high level of vulnerability due to social and health factors. This study showed a different dissemination pattern of COVID-19 mortality between the two waves: a spatial non-stationarity followed by a spatial stationarity in the relationships between the COVID-19 mortality rate and its potential drivers.