Socio-economic inequality in national incidence and mortality rates of COVID-19 in India: An Ecological Study

Background: There are sufficient evidences on the association of epidemiological and clinical features of the patients with COVID-19 but still there are paucity of evidences on socio-economic aspects of this disease. An ecological study has been carried out with aim to assess the associations of the Human Development Index (HDI) and its components of each states and Union territories in India with incidence and mortality from COVID-19. Methods: Information on confirmed cases and deaths have been extracted from the data on the website of Covid India Organization and the data on HDI and its components have been extracted from various national and international agencies. Regression analysis was performed which showed a direct significant association (p-values<0.05) of incidence and mortality rates with HDI and its components at the national level. Concentration index was estimated to measure socio-economic inequality in COVID-19 incidence and mortality rates with 95% confidence interval (CI), which were 0.41 (0.27–0.54) and 0.42 (0.26–0.58) for incidence and mortality rates of COVID-19 respectively. Results: The high incidence and mortality rates of COVID-19 in states and union territories of India with high HDI and its components warrant priority for interventions by the national health policy-makers. Cases detection and screening facilities need to be scaled up in states and UTs with low incidence and mortality rates to minimize the under-reporting of the cases