The socio-economic determinants of COVID-19: A spatial analysis of German county level data

The study explores the association of socioeconomic, demographic, and health-related variables at the regional level with COVID-19 related cases and deaths in Germany during the so-called first wave through mid-June 2020. Multivariate spatial models include the 401 counties in Germany to account for regional interrelations and possible spillover effects. The case and death numbers are, for example, significantly positively associated with early cases from the beginning of the epidemic, the average age, the population density and the share of people employed in elderly care. By contrast, they are significantly negatively associated with the share of schoolchildren and children in day care as well as physician density. In addition, significant spillover effects on the case numbers of neighbouring regions were identified for certain variables, with a different sign than the overall effects, giving rise to further future analyses of the regional mechanisms of action of COVID-19 infection. The results complement the knowledge about COVID-19 infection beyond the clinical risk factors discussed so far by a socio-economic perspective at the ecological level.