Work

Dynamics of social inequalities in severe COVID-19 outcomes in metropolitan France from 2020 to 2022

Year: 2025

Type: article

Abstract: Evidence on the dynamics of social inequalities throughout the COVID-19 healthcare pathway in France is sparse. This study examined the relationship between area-level social deprivation and hospitalizations, intensive care unit (ICU) admissions, and deaths in metropolitan France during five pandemic waves (wave 2: 1 July-16 December 2020, wave 3: 23 December 2020-16 June 2021, wave 4: 23 June-20 October, wave 5: 27 October-2 March 2022, wave 6: 9 March-31 August 2022). Using comprehensive data from the French national surveillance hospitalization database, we built spatiotemporal Bayesian Poisson regression models to estimate, for each pandemic wave, Incidence Rate Ratios (IRR) and 95% credible interval (CrI) for the association between outcomes and quintiles of the European Deprivation Index, among the French general population and infected persons. We show a growing social gradient for all outcomes among infected persons. For people living in the most deprived areas the IRR increases from 1.43 95%CrI (1.39-1.47) (wave 2) to 1.60(1.55-1.66) (wave 6) for hospitalizations, from 1.57(1.49-1.66) to 1.72(1.58-1.87) for ICU admissions, and from 1.35(1.28-1.42) to 1.70(1.55-1.87) for in-hospital deaths. Among the general population we also observe a social gradient in all outcomes which declines after wave 5. We find a social gradient related to severe forms of COVID-19 over the five pandemic waves studied, and this gradient increases among persons infected with the disease. Our study highlights the importance of considering social position when managing pandemics and underscores the need for targeted interventions for specific populations to minimize health inequalities. The COVID-19 pandemic has exacerbated social inequalities in health, yet how these inequalities changed across successive waves and stages of disease severity remains poorly understood. We analyzed the link between neighborhood social deprivation and the risk of hospitalization, ICU admission, and in-hospital death using national hospitalization data from metropolitan France across five pandemic waves (July 2020–August 2022). Our findings reveal that individuals living in disavantaged neighborhood faced significantly higher risks of severe outcomes, even after widespread vaccine rollout. These inequalities intensified among infected individuals over waves, while partially declining in the general population. Our findings suggest that structural factors—such as comorbidity burden, occupational exposure, and healthcare access—play a major role and highlight the need to integrate equity considerations into pandemic preparedness and routine health policies. Smaili et al. examine the association between social factors and severe COVID-19 across five pandemic waves in metropolitan France. Their results show a persistent gradient, with more socioeconomically deprived populations facing higher risks of severe disease over time.

Source: Communications Medicine

DOI: 10.1038/s43856-025-01214-w