@article{fdi:010081281,
  title = {{F}actors associated with the spatial heterogeneity of the first wave of {COVID}-19 in {F}rance : a nationwide geo-epidemiological study},
  author = {{G}audart, {J}. and {L}andier, {J}ordi and {H}uiart, {L}. and {L}egendre, {E}. and {L}ehot, {L}. and {B}endiane, {M}. {K}. and {C}hiche, {L}. and {P}etitjean, {A}. and {M}osnier, {E}. and {K}irakoya-{S}amadoulougou, {F}. and {D}emongeot, {J}. and {P}iarroux, {R}. and {R}ebaudet, {S}.},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground {T}he objective of this study was to better understand the factors associated with the heterogeneity of in-hospital {COVID}-19 morbidity and mortality across {F}rance, one of the countries most affected by {COVID}-19 in the early months of the pandemic. {M}ethods {T}his geo-epidemiological analysis was based on data publicly available on government and administration websites for the 96 administrative departments of metropolitan {F}rance between {M}arch 19 and {M}ay 11, 2020, including {P}ublic {H}ealth {F}rance, the {R}egional {H}ealth {A}gencies, the {F}rench national statistics institute, and the {M}inistry of {H}ealth. {U}sing hierarchical ascendant classification on principal component analysis of multidimensional variables, and multivariate analyses with generalised additive models, we assessed the associations between several factors (spatiotemporal spread of the epidemic between {F}eb 7 and {M}arch 17, 2020, the national lockdown, demographic population structure, baseline intensive care capacities, baseline population health and health-care services, new chloroquine and hydroxychloroquine dispensations, economic indicators, degree of urbanisation, and climate profile) and in-hospital {COVID}-19 incidence, mortality, and case fatality rates. {I}ncidence rate was defined as the cumulative number of in-hospital {COVID}-19 cases per 100 000 inhabitants, mortality rate as the cumulative number of in-hospital {COVID}-19 deaths per 100 000, and case fatality rate as the cumulative number of in-hospital {COVID}-19 deaths per cumulative number of in-hospital {COVID}-19 cases.    {F}indings {F}rom {M}arch 19 to {M}ay 11, 2020, hospitals in metropolitan {F}rance notified a total of 100 988 {COVID}-19 cases, including 16 597 people who were admitted to intensive care and 17 062 deaths. {T}here was an overall cumulative in-hospital incidence rate of 155.6 cases per 100 000 inhabitants (range 19.4-489.5), in-hospital mortality rate of 26.3 deaths per 100 000 (1 .1-119 .2), and in-hospital case fatality rate of 16.9% (4.8-26.2). {W}e found clear spatial heterogeneity of in-hospital {COVID}-19 incidence and mortality rates, following the spread of the epidemic. {A}fter multivariate adjustment, the delay between the first {COVID}-19-associated death and the onset of the national lockdown was positively associated with in-hospital incidence (adjusted standardised incidence ratio 1.02, 95% {CI} 1.01-1.04), mortality (adjusted standardised mortality ratio 1.04, 1.02-1.06), and case fatality rates (adjusted standardised fatality ratio 1.01, 1.01-1.02). {M}ortality and case fatality rates were higher in departments with older populations (adjusted standardised ratio for populations with a high proportion older than aged >85 years 2.17 [95% {CI} 1.20-3.90] for mortality and 1.43 [1.08-1.88] for case fatality rate). {M}ortality rate was also associated with incidence rate (1.0004, 1.0002-1.001), but mortality and case fatality rates did not appear to be associated with baseline intensive care capacities. {W}e found no association between climate and in-hospital {COVID}-19 incidence, or between economic indicators and in-hospital {COVID}-19 incidence or mortality rates. {I}nterpretation {T}his ecological study highlights the impact of the epidemic spread, national lockdown, and reactive adaptation of intensive care capacities on the spatial distribution of {COVID}-19 morbidity and mortality. {I}t provides information for future geo-epidemiological analyses and has implications for preparedness and response policies to current and future epidemic waves in {F}rance and elsewhere.},
  keywords = {{FRANCE}},
  booktitle = {},
  journal = {{L}ancet {P}ublic {H}ealth},
  volume = {6},
  numero = {4},
  pages = {{E}222--{E}231},
  ISSN = {2468-2667},
  year = {2021},
  DOI = {10.1016/s2468-2667(21)00006-2},
  URL = {https://www.documentation.ird.fr/hor/fdi:010081281},
}