The Relationship Between Poverty and COVID-19 Infection and Case-Fatality Rates in Germany during the First Wave of the Pandemic

The relationship between poverty and the infection and case-fatality rates of COVID-19 has emerged as a controversial but understudied topic. In previous studies and reports from the UK and US evidence emerged that poverty-related indicators had a significant statistical effect on case and mortality rates on district level. For Germany, it has largely been assumed that poverty is an equally relevant factor influencing the transmission rates of the outbreak. This was mostly due to anecdotal evidence from local outbreaks in meat processing plants and reported incidents of infection clusters in poorer city districts. This paper addresses the lack of statistical evidence and investigates thoroughly the link between poverty-related indicators and detected infection and mortality rates of the outbreak using multivariate, multilevel regression while also considering the urban-rural divide of the country. As proxies for poverty the unemployment rate, the per capita presence of general practitioners (physicians), per capita GDP, and the rate of employees with no professional job training is evaluated in relation to the accumulated case and mortality numbers on district level taken from RKI data of June and July 2020. Interestingly, the study finds no general evidence for a poverty-related effect on mortality for German districts during the first wave in the first half of 2020. Furthermore, only employment in low qualification jobs approximated by the job training variable consistently affected case numbers in urban districts in the expected direction.