Covid-19 increased regional inequalities in mortality, with the most vulnerable regions most affected

The Covid-19 pandemic had the greatest impact in the most vulnerable Czech regions, which were already struggling before the crisis. Regional differences in mortality rates have increased, with population structure playing a major role, as well as the acceptance or non-acceptance of preventive health measures, specifically vaccination. This follows from research by scientists at the SYRI National Institute, which has just been published in the prestigious scientific journal Applied Geography.

Economic, health or other types of crises tend to affect more vulnerable populations while increasing inequalities. This was again evident during the pandemic, as tested by SYRI researchers using mortality data from individual districts. "The results confirm the widening of regional disparities during the health crisis, with the most vulnerable regions hit hardest. Regional differences in mortality rates have thus increased," said Pavlína Netrdová from SYRI and the Faculty of Science at Charles University.

The average pre-pandemic two-year mortality rate (2018-2019) in the Czech Republic was 13.66 deaths per 1,000 population. During the pandemic years of 2020 and 2021, this rate increased to 15.88 per 1,000 population, an increase of 16.2%. Interestingly, the same regions as before the pandemic were once again worse off, especially northwest Bohemia and eastern Moravia. On the other hand, large cities such as Prague and Brno fared best.

"Our findings reveal the significant effects of regional health outcomes, which are key to identifying vulnerable and high-risk regions and thus enabling effective planning and policy responses at the district level," added co-author Klára Hulíková Tesárková. In her view, regional differences were influenced by the acceptance of preventive health measures, i.e. vaccination.

For instance, in northwestern Bohemia, mortality levels were already unfavourable before the pandemic. These are districts with higher unemployment rates and lower levels of education. SYRI researchers say that this lack of social capital is a key factor because it affects social and institutional trust, and thus translates into, for example, respect for rules, which was crucial during the pandemic. Moreover, lower education often does not allow working from home. "These are the main reasons why this region fared worse than others," Netrdová said.

Scientists found the second group of heavily affected districts in the eastern part of Moravia. Since mortality rates in these districts were around the national average before the pandemic, attitudes towards the Covid-19 vaccine in particular played a major role.

The study's findings provide empirical evidence that can serve as a basis for effective decision-making in future health crises. "Understanding and considering the underlying factors and mechanisms that contribute to increased disparities and vulnerability at the regional level allows for more effective targeting of prevention and promotion of sustainable conditions for improving the quality of life in a given area," summarised study co-author and SYRI research group leader Dagmar Dzúrová. Simply put, prevention can deliberately target vulnerable populations or specific vaccination campaigns. The results also suggest the need to work with regional differences in the future. "Interventions should be based on the latest scientific evidence, location and context," Netrdova said.

Link to the article: Exploring vulnerability amplification in regional health inequality: COVID-19 case study in Czechia - ScienceDirect