Socioeconomic position and SARS-CoV-2 infections: seroepidemiological findings from a German nationwide dynamic cohort

Hoebel, J.; Grabka, M. M.; Schroeder, C.; Haller, S.; Neuhauser, H.; Wachtler, B.; Schaade, L.; Liebig, S.; Hoevener, C.; Zinn, S.

Background: Evidence on the relationship between socioeconomic position (SEP) and infections with the SARS-CoV-2 coronavirus is still limited as most of the available studies are ecological in nature. This is the first German nationwide study to examine differences in the risk of SARS-CoV-2 infections according to SEP at the individual level. Methods: The 'CORONA-MONITORING bundesweit' (RKI-SOEP) study is a seroepidemiological survey among a dynamic cohort of the German adult population (n=15,122; October 2020 to February 2021). Dried blood samples were tested for SARS-CoV-2 antibodies and oral-nasal swabs for viral RNA. SEP was measured by education and income. Robust logistic regression was used to examine adjusted associations of SARS-CoV-2 infections with SEP. Results: 288 participants were seropositive, PCR-positive, or self-reported a previous laboratory-confirmed SARS-CoV-2 infection. The adjusted odds of SARS-CoV-2 infection were 1.87-fold (95% confidence interval [CI]=1.06-3.29) higher among low-educated than highly educated adults. Evidence was weaker for income differences in infections (odds ratio=1.65; 95% CI=0.89-3.05). Highly educated adults had lower odds of undetected infection. Conclusions: The results indicate an increased risk of SARS-CoV-2 infection in low-educated groups. To promote health equity in the pandemic and beyond, social determinants should be addressed more in infection protection and pandemic planning.