An Ecological Study Relating the SARS-CoV-2 Epidemiology with Health-Related, Socio-Demographic, and Geographical Characteristics in South Tyrol (Italy)

The literature associating the spread of SARS-CoV-2 with the healthcare-related, geographical, and demographic characteristics of the territory is inconclusive and contrasting. We studied these relationships during winter 2021/2022 in South Tyrol, a multicultural Italian alpine province, performing an ecological study based on the 20 districts of the area. Data about incidence, hospitalization, and death between November 2021 and February 2022 were collected and associated to territorial variables via bivariate analyses and multivariate regressions. Both exposure variables and outcomes varied widely among districts. Incidence was found to be mainly predicted by vaccination coverage (negative correlation). Mortality and ICU admission rates partially followed this distribution, while the case fatality rate was inversely correlated to average salary, and hospital admission rates increased where hospitals capacity was higher, and from the southern to the northern border of the province. These findings, besides confirming the efficacy of vaccination in preventing both new and severe SARS-CoV-2 cases, highlight that several geographical and socio-demographic variables can be related to disease epidemiology. Remote areas with wage gaps and lower access to care suffered most from the pandemic. Our findings, therefore, underly the existence of health inequity issues that need to be targeted by implementing specifically tailored public health interventions.