Introduction We describe COVID-19 morbidity, mortality, case fatality and excess death
in a country-wide study of municipalities in Hungary, exploring the association with
socioeconomic status. Methods The spatial distribution of morbidity, mortality and
case fatality was mapped using hierarchical Bayesian smoothed indirectly standardised
ratios. Indirectly standardised ratios were used to evaluate the association between
deprivation and the outcome measures. We looked separately at morbidity and mortality
in the 10 districts with the highest and 10 districts with the lowest share of Roma
population. Results Compared with the national average, the relative incidence of
cases was 30%-36% lower in the most deprived quintile but the relative mortality and
case fatality were 27%-32% higher. Expressed as incidence ratios relative to the national
average, the most deprived municipalities had a relative incidence ratio of 0.64 (CI:
0.62 to 0.65) and 0.70 (CI: 0.69 to 0.72) for males and females, respectively. The
corresponding figures for mortality were 1.32 (CI: 1.20 to 1.44) for males and 1.27
(CI: 1.16 to 1.39) for females and for case fatality 1.27 (CI: 1.16 to 1.39) and 1.32
(CI: 1.20 to 1.44) for males and females, respectively. The excess death rate (per
100 000) increased with deprivation levels (least deprived: 114.12 (CI: 108.60 to
119.84) and most deprived: 158.07 (CI: 149.30 to 167.23)). The 10 districts where
Roma formed the greatest share of the population had an excess mortality rate 17.46%
higher than the average for the most deprived quintile. Conclusions Those living in
more deprived municipalities had a lower risk of being identified as a confirmed COVID-19
case but had a higher risk of death. An inverse association between trends in morbidity
and mortality by socioeconomic conditions should be a cause for concern and points
to the need for responses, including those involving vaccination, to pay particular
attention to inequalities and their causes.
