Socioeconomic, demographic and healthcare determinants of the COVID-19 pandemic: an ecological study of Spain

Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic has posed a major challenge to health, economic and political systems around the world. Understanding the socioeconomic, demographic and health determinants affecting the pandemic is of interest to stakeholders. The purpose of this ecological study is to analyse the effect of the different socioeconomic, demographic and healthcare determinants on the mortality rate and estimated cumulative incidence of COVID-19 first wave in the Spanish regions. Methods: From the available data of the 17 Spanish regions (Autonomous Communities), we have carried out an ecological study through multivariate linear regression using ordinary least squares. To do this, we conducted an analysis using two distinct dependent variables: the logarithm of mortality rate per 1,000,000 inhabitants and the estimated cumulative incidence. The study has 12 explanatory variables. Results: After applying the backward stepwise multivariate analysis, we obtained a model with nine significant variables at different levels for mortality rate and a model with seven significant variables for estimated cumulative incidence. Among them, six variables are statistically significant and of the same sign in both models: ¿Nursing homes beds¿, ¿Proportion of care homes over 100 beds¿, ¿Log GDP per capita¿, ¿Aeroplane passengers¿, ¿Proportion of urban people¿, and the dummy variable ¿Island region¿. Conclusions: The different socioeconomic, demographic and healthcare determinants of each region have a significant effect on the mortality rate and estimated cumulative incidence of COVID-19 in territories where the measures initially adopted to control the pandemic have been identical. Keywords: Determinants, Spain, COVID-19, Ecological Study