How the COVID-19 infection and deaths are shaped by socioeconomic inequities and air pollution exposure in Mumbai, India?

Background: The COVID-19 pandemic caused a global health crisis and exposed the low socioeconomic groups to higher exposure and death due to the existing social inequalities. India witnessed three unprecedented waves of COVID infection and deaths. However, a systematic analysis of the impact of socioeconomic inequities and other environmental factors on COVID-19 infection and mortality are not well examined in India. Aim: The present study aims to understand the impact of socioeconomic inequities and air pollution on COVID-19 infection and deaths in Mumbai, India. Methods: Ward-level data on COVID-19 cases and deaths from 24 wards is obtained from the Municipal Corporation of Greater Mumbai. Socioeconomic data is acquired from the official Govt. of India 2011 census. Bivariate and multivariate regression is applied to examine the impact of various socioeconomic factors on COVID fatalities and infections. Results: Mumbai reported 1,032,563 positive cases with an overall mortality rate of 18.9. The maximum mortality (41.9) and recovery rate (991.4) were observed in wards B and A in south Mumbai. A significant negative correlation (r=-0.55) was observed between deaths and the total population, irrespective of gender. Education (defined by literacy rate) showed a positive association with the COVID cases for both genders, suggesting no significant disparity based on gender and education (p<0.05). The homeless population depicted a positive correlation with mortality rates and positive cases, indicating the role of economic inequities. The higher population density in the wards may have caused higher mortalities, as suggested by a significant positive association (r= 0.46). Conclusion: Our initial analysis suggests the influence of healthcare and housing affordability on the mortality rates, whereas the total positive cases seem to be driven by the non-slum population. The effect of other socioeconomic variables and air pollution, and multivariate analysis is currently underway. Keywords: COVID-19, Socioeconomic inequity, Air Pollution, Healthcare, Mortality