Socioeconomic determinants of protective behaviors and contact patterns in the post-COVID-19 pandemic era: A cross-sectional study in Italy

Socioeconomic inequalities significantly influence infectious disease outcomes, as seen with COVID-19, but the pathways through which socioeconomic conditions affect transmission dynamics remain unclear. To address this, we conducted a survey representative of the Italian population, stratified by age, gender, geographical area, city size, employment status, and education level. The survey’s final aim was to estimate differences in contact and protective behaviors across various population strata, both of which are crucial for understanding transmission dynamics. Our initial insights based on the survey indicate that years after the pandemic began, the perceived impact of COVID-19 on professional, economic, social, and psychological dimensions varied across socioeconomic strata, extending beyond the epidemiological outcomes. This reinforces the need for approaches that systematically consider socioeconomic determinants. In this context, using generalized linear models, we identified associations between socioeconomic factors and vaccination status for both COVID-19 and influenza, as well as the influence of socioeconomic conditions on mask-wearing and social distancing. Importantly, we also observed differences in contact behaviors based on employment status while education level did not show a significant association. These findings highlight the complex interplay of socioeconomic and demographic factors in shaping protective behavior and contact patterns. Understanding these dynamics can contribute to the improvement of epidemic models and better guide public health efforts for at-risk groups.Author summary: COVID-19 outcomes have been shown to vary across different socioeconomic groups, but the mechanisms by which socioeconomic conditions influence transmission are not yet fully understood. To gain insight into these relationships, we conducted a contact survey representative of the Italian population, incorporating socioeconomic dimensions to capture potential differences in contact patterns and protective behaviors - two critical factors in the spread of COVID-19. This survey aimed to gather data on participants’ perceptions of the pandemic’s impact, and their adoption of non-pharmaceutical interventions (NPIs) such as mask-wearing and social distancing, vaccination status, and contact behavior patterns. By analyzing this data, we were able to identify associations between socioeconomic factors and vaccination status for both COVID-19 and influenza, as well as the impact of socioeconomic conditions on mask-wearing and social distancing practices. Notably, we observed variations in contact behaviors based on employment status, while education level did not show a significant association. In summary, the survey results enabled us to pinpoint specific socioeconomic conditions linked to variations in contact and protective behaviors. This understanding is crucial for identifying when and which socioeconomic factors should be considered in epidemic modeling to accurately capture the drivers, whether contact patterns or protective measures, of infectious disease transmission.