COVID-19 incidence and outcome by affluence/deprivation across three pandemic waves in Ireland: A retrospective cohort study using routinely collected data
McKeown, Declan; McCourt, Angela; Hendrick, Louise et al
School of Nursing, Psychotherapy and Community Health

Initially called “The Great Leveller”, 1918’s influenza pandemic appeared to affect rich and poor equally. Subsequent research, however, showed a disproportionate impact on poorer populations. More recently, seasonal influenza has mirrored this effect, but without yet revealing a causal relationship.

When the World Health Organisation declared a COVID-19 pandemic, a common refrain was that “we are all in this together”. However, early reports showed greater mortality rates from COVID-19 in areas with lower income and higher unemployment. In the United Kingdom, more deprived areas reported twice the mortality rate of affluent neighbourhoods and similar patterns were observed in South America, and in the Asia-Pacific region.

Debate in the UK and US has focussed on ethnicity, rather than deprivation, as being the more critical determinant of COVID-19 in inequitable societies. However, Ireland’s population does not display the same level of ethnic diversity as other, larger countries. Other factors linked with COVID-19 incidence and mortality have been proposed, including age, comorbidity, urban density and health-seeking behaviour.

The objective of this paper is to explore COVID-19 incidence and outcomes across three pandemic waves in the context of affluence and deprivation in Ireland using the Pobal Haase-Pratschke (HP) Relative Index, given Ireland’s unique demographic structure.

The study suggests that COVID-19 spreads easily through all strata of society and particularly in deprived populations; however this was not a consistent finding. Ireland is ethnically more homogenous than other countries reporting a larger deprivation gradient, and in such societies, structural racial differences may contribute more to poor COVID outcomes than elements of deprivation.