Spatial risk factors for Pillar 1 COVID-19 excess cases and mortality in rural eastern England, UK

Brainard, Julii, Rushton, Steven, Winters, Tim and Hunter, Paul ORCID: (2022) Spatial risk factors for Pillar 1 COVID-19 excess cases and mortality in rural eastern England, UK. Risk Analysis, 42 (7). pp. 1571-1584. ISSN 0272-4332

[thumbnail of Published_Version]
PDF (Published_Version) - Published Version
Available under License Creative Commons Attribution.

Download (1MB) | Preview


Understanding is still developing about spatial risk factors for COVID-19 infection or mortality. This is a secondary analysis of patient records in a confined area of eastern England, covering persons who tested positive for SARS-CoV-2 through end May 2020, including dates of death and residence area. We obtained residence area data on air quality, deprivation levels, care home bed capacity, age distribution, rurality, access to employment centers, and population density. We considered these covariates as risk factors for excess cases and excess deaths in the 28 days after confirmation of positive Covid status relative to the overall case load and death recorded for the study area as a whole. We used the conditional autoregressive Besag—York–Mollie model to investigate the spatial dependency of cases and deaths allowing for a Poisson error structure. Structural equation models were applied to clarify relationships between predictors and outcomes. Excess case counts or excess deaths were both predicted by the percentage of population age 65 years, care home bed capacity and less rurality: older population and more urban areas saw excess cases. Greater deprivation did not correlate with excess case counts but was significantly linked to higher mortality rates after infection. Neither excess cases nor excess deaths were predicted by population density, travel time to local employment centers, or air quality indicators. Only 66% of mortality was explained by locally high case counts. Higher deprivation clearly linked to higher COVID-19 mortality separate from wider community prevalence and other spatial risk factors.

Item Type: Article
Additional Information: Funding Information: Professor Hunter and Dr. Brainard were funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Emergency Preparedness and Response at King's College London in partnership with Public Health England (PHE) and collaboration with the University of East Anglia. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, UEA, the Department of Health or PHE.
Uncontrolled Keywords: ageing population,air quality,covid-19,deprivation,rurality,safety, risk, reliability and quality,physiology (medical),sdg 11 - sustainable cities and communities ,/dk/atira/pure/subjectarea/asjc/2200/2213
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups: Faculty of Medicine and Health Sciences > Research Groups > Epidemiology and Public Health
Faculty of Medicine and Health Sciences > Research Groups > Public Health and Health Services Research (former - to 2023)
Faculty of Social Sciences > Research Centres > Water Security Research Centre
Faculty of Medicine and Health Sciences > Research Centres > Population Health
Related URLs:
Depositing User: LivePure Connector
Date Deposited: 06 Oct 2021 01:59
Last Modified: 19 Oct 2023 03:06
DOI: 10.1111/risa.13835


Downloads per month over past year

Actions (login required)

View Item View Item