BACKGROUND: 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). METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
Auteur : Smaïli Sabira, Pelat Camille, Chatignoux Edouard, Sireyjol Antoine, Kelly-Irving Michelle, Gaudart Jean, Delpierre Cyrille, Vandentorren Stéphanie
Communications medicine, 2025, vol. 5, n°. 1, p. 516
