Social inequalities in SARS-CoV-2 infection in France: An intersectional analysis

Background

Inequalities in SARS-CoV-2 infection across social dimensions have been largely reported in isolation or through limited intersections (i.e., age and gender or socioeconomic position). This study aims to fill this gap by investigating how intersecting social positions shape SARS-CoV-2 infection in France using an intersectional framework.

Methods

Study sample was drawn from the nationally representative EpiCoV (Epidémiologie et Conditions de Vie) cohort (Nov-Dec 2020), including 18-64 years individuals in metropolitan France (N = 42,786). Intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (I-MAIHDA) logistic model was applied to explore intersectional inequalities in SARS-CoV-2 seropositivity. Individuals were nested within 150 intersectional strata defined by the combination of age, gender, social class and racial status.

Results

The findings showed notable inequalities in SARS-CoV-2 infection across intersectional strata (null model VPC = 4.7%, 95% CI:3.00,7.00), mainly driven by additive effects (PCV= 90.4%). Younger age, being a woman, and being of French overseas territories (DROM), Asian and African origin were associated with higher risk of infection. Racial status was the primary driver of these inequalities. Predicted seropositivity varied significantly across strata (6.5%, [95% CI: 5.14, 8.42] to 22.9% [95%CI:18.35, 28.33]), with the higher seropositivity observed among younger women of African and Asian origin.

Conclusions

Overall, our results suggest that infection-prevention strategies should follow a proportionate universalism principle in order to address specific inequalities and the needs of multiply marginalized groups. Further, this study highlights importance of systematically including racial status as a critical axis of discrimination in infectious health inequities in France and similar high-income countries.

Key messages

• Using I-MAIHDA, our study revealed patterned intersectional inequalities in SARS-CoV-2 infection in France, with highest risk among younger women of African and Asian origin.

• Our study highlights the importance of intersectional approach in quantitative research and systematically including racial status as a critical axis of discrimination in infectious health inequities.