Association between area deprivation index and concerns to COVID-19: A multi-level analysis of individual and area factors

The coronavirus disease 2019 (COVID-19) pandemic has been one of the most serious global threats to public health recently. The present study examined whether area deprivation is associated with concerns related to COVID-19 using large nationwide data across South Korea. We used nationwide 2020 Korea Community Health Survey and official government database. Of the 225,680 included participants, 123,324 (54.6%) were women, and the mean age was 54.9 [17.8] years old. We classified the Area deprivation index (ADI) into Quartile 1 (Least deprived); Quartile 2; Quartile 3; and Quartile 4 (Most deprived). Our primary outcome was the concerns related to COVID-19 (0–16 scores). Multilevel regression analysis was conducted. The mean score of concerns related to COVID-19 was 11.3 [3.2] in the total population. 13.5% of the variability in the scores of concerns related to COVID-19 was accounted for by district areas. Area with Q4 of ADI were associated with an increased score of concerns related to COVID-19 (Q1: reference; Q2: β = 0.218, SE = 0.119, FDR adj.p-value = 0.085; Q3: β = 0.235, SE = 0.133, FDR adj.p-value = 0.094; Q4: β = 0.252, SE = 0.109, FDR adj.p-value = 0.029). 19–49 groups in area with Q4 of ADI were associated with an increase in scores of concerns related to COVID-19 than other age groups in area with Q4 of ADI. Area with Q4 of ADI were associated with a score of concern of being criticized if getting infected compared to area with Q1 of ADI. We found that the highest quartile ADI was associated with greater concerns related to COVID-19. By identifying vulnerable population to concerns related to COVID-19, health systems may consider preventive intervention to mitigate mental health issues. •Women, lower household income, married, more depressed individuals had higher concerns related to COVID-19.•Concerns related to COVID-19 was accounted 13.5% by area characteristics.•Individuals lived in most deprived area had higher concerns of COVID-19.•Aged 19–49 lived in most deprived area had higher concerns of COVID-19.•“Concerns of being blamed by others of infection” was the most influential.