Distributional impact of COVID-19: regional inequalities in cases and deaths in Spain during the first wave

Spain is being hit hard by the COVID-19 pandemic. During the first wave, from mid-March to early June 2020, the disease caused nearly 30,000 deaths in a population of 47 million. This article quantifies the unevenness in the distribution of epidemiological variables across the Spanish territory. The study is relevant because Spain is divided into regions that hold devolved authority for providing health care services to their citizens. Using inequality metrics, the study shows: i) By mid-April inequality in the epidemiological variables reached a stationary value that changed little with the incorporation of new cases and deaths. At the end of the outbreak, cumulative cases and deaths were fairly unevenly distributed across Spanish provinces; ii) Inequality shows a monotonic downward trend throughout the outbreak showing a decrease from the onset to the end ranging from 22% to 49% in cases and between 17% and 42% in deaths; iii) Over 90% of the inequality observed can be attributed to differences between regions, while less than 10% is due to the differences across provinces within regions. Awareness of the existence and nature of the inequality observed in the epidemiological variables is needed to develop successful policies to improve health services in Spain.Spanish Ministry of Economy, Industry and Competitiveness (ECO2016-78819-R, AEI/FEDER, UE), Spanish Ministry of Science and Innovation (PID2019-108718GB-I00), Basque Government (BiRTE, IT-1336-19) and University of the Basque Country (PES20/44)