Must Whatever Goes up Come Down? Mortality Gradients in the Emergence of COVID-19

Jordan Klein, Max Planck Institute for Demographic Research (MPIDR)

Disentangling the roles of disease-specific interventions and disease-agnostic pre-existing inequities in the production of COVID-19 mortality gradients remains an empirical challenge due to the lack of counterfactual evidence from a scenario in which no interventions were implemented in response to the pandemic. To address this knowledge gap, I model the production of COVID-19 mortality gradients in Brazil with a geospatially explicit, data-driven compartmental epidemiological model inspired by novel theoretical frameworks of social gradients in emerging infectious diseases. Modeling Brazil's municipalities as individual units, I parameterize pre-existing inequities through disparities in household transmission and infection fatality rates, and model two types of interventions: NPIs and vaccination, considering counterfactual scenarios of intervention implementation, including hypothetical scenarios with higher intervention adoption in lower socioeconomic status municipalities. The findings of this study have crucial implications for countering pre-existing inequities in vulnerability to emerging infectious diseases through a more equitable distribution of interventions. This is the first study to incorporate novel theoretical frameworks dissecting the pathways contributing to social gradients in emerging infectious disease mortality into mechanistic epidemiological models, and the first to model the socio-economic drivers of COVID mortality inequalities in Brazil on a national scale, with geospatial specificity, while utilizing real-world data-informed parameters.

Keywords: Mortality and Longevity, Inequality, Disadvantage and Discrimination, Simulation , Spatial Demography

See paper.