COVID-19 infection rates and social disadvantage in Ireland: An area-level analysis

Existing research has shown that deprived areas were impacted to a greater extent by the COVID-19 pandemic in a multitude of ways but particularly in terms of the health impact. This research examines the health impact of the pandemic on people living in disadvantaged areas in Ireland. Health impacts are measured in terms of COVID-19 infection rates and ICU admission rates. The analysis is conducted by using area-level COVID-19 infection rate data at the Electoral Division (ED) level for Ireland and ED-level measures of deprivation based on the Pobal Haase Pratschke Relative Deprivation Index (Pobal HP Deprivation Index). Additional area-level information from the Census is also utilised. This work builds on previous work that examined the economic impact of COVID-19 on disadvantaged areas in Ireland in terms of pandemic-related unemployment. 

Descriptive analysis suggests that the average COVID-19 infection rate in the most deprived areas was significantly higher than the average in more affluent areas. More specifically, the average infection rate was over 50 per cent higher in the most deprived areas. The average infection rate in the most deprived areas was 5.6% compared to 3.7% in more affluent areas. 

The results of formal modelling show that infection rates were highest in the most deprived areas even when controlling for ethnic make-up, age structure at the area level and the presence of communal establishments. More precisely, when these area-level factors are controlled for, we find that the most deprived areas had infection rates more than a third higher than more affluent areas. Areas with higher shares of ethnic minorities as well as areas with communal establishments also had higher infection rates. 

Infection rates were also higher in non-deprived areas located in border counties. This latter finding in particular has significant policy ramifications given the porous border between Ireland and Northern Ireland. 

In terms of ICU admission, deprivation is not correlated directly with high ICU admission rates due to COVID-19; however, it appears to be having an indirect impact through other area-level characteristics. High ICU admission rates are more likely to manifest in areas with communal establishments as well as areas with higher proportions of people with underlying health conditions. Areas with higher proportions of racial/ethnic minorities were also more likely to have high ICU admission rates. These factors are highly correlated with area-level deprivation so while deprivation does not have a direct impact on ICU admission rates at the area level, it appears to be mediated through these other area-level factors, e.g. ethnicity, age and health. 

From a policy perspective, this research suggests that the underlying markers of deprivation which differ spatially across Ireland influence the prevalence and severity of COVID-19. Therefore, there are important lessons to be learned about health inequalities during a pandemic as well as the impact of other pre-existing inequalities which may impact the prevalence of COVID-19.