Socioeconomic determinants of COVID-19 incidence in a German rural area.

INTRODUCTION: This study examines the relationship between local-level socioeconomic factors and the incidence of COVID-19 infections in rural Germany. It does so by analyzing small spatial units (i.e. municipalities in the district of Bad Kreuznach, Rhineland-Palatinate), thereby addressing the research gap in the context of rural areas. By examining localized dynamics, the study sheds light on the socioeconomic determinants. METHODS: An anonymized dataset of all reported COVID-19 cases of unvaccinated persons with confirmed SARS-CoV-2 infection in the rural district of Bad Kreuznach between 03/04/2020 and 01/06/2021 was analyzed using a negative binomial generalized linear model. The following socioeconomic factors were considered: GISD employment subscore, income tax per resident (at municipality and municipal association levels), population density, number of residents, presence of a hospital, and regional population potential. RESULTS: A statistically significant influence of the variable income tax per capita was found at both the municipal level (coefficient − 1.072; p = 0.0224) and at the municipal association level (coefficient 2.914; p = 0.0033). A significant correlation was also found with the presence of a hospital (coefficient 0.773; p = 0.0091). Excluding the city of Bad Kreuznach did not change the main results. DISCUSSION: In rural areas, the influence of socioeconomic factors was less pronounced than in studies of metropolitan regions and larger spatial units. In this study, only income tax per capita and the presence of a hospital were statistically significant, which may have been affected by unobserved confounders. Further research on smaller spatial units is needed to better understand the local impacts of socioeconomic factors and support targeted public health policy decisions.