@article {Oroszie006427, author = {Beatrix Oroszi and Attila Juh{\'a}sz and Csilla Nagy and Judit Krisztina Horv{\'a}th and Martin McKee and R{\'o}za {\'A}d{\'a}ny}, title = {Unequal burden of COVID-19 in Hungary: a geographical and socioeconomic analysis of the second wave of the pandemic}, volume = {6}, number = {9}, elocation-id = {e006427}, year = {2021}, doi = {10.1136/bmjgh-2021-006427}, publisher = {BMJ Specialist Journals}, abstract = {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\%{\textendash}36\% lower in the most deprived quintile but the relative mortality and case fatality were 27\%{\textendash}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.Extracted data sheets and data dictionary will be made available immediately after publicationof this Article upon request to the corresponding author R{\'o}za {\'A}d{\'a}ny DSc. These data sheetswill be shared with researchers who provide a methodologically sound proposal, after theauthors{\textquoteright} review of requests. Requesters will need to sign a data access agreement.}, URL = {https://gh.bmj.com/content/6/9/e006427}, eprint = {https://gh.bmj.com/content/6/9/e006427.full.pdf}, journal = {BMJ Global Health} }