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Cited by 431COVID-19 epidemiological studiesPublic Health and Social InequalitiesCOVID-19 Clinical Research Studies

Socioeconomic status determines COVID-19 incidence and related mortality in Santiago, Chile

Open access
Mena, Gonzalo E., Martinez, Pamela P., Mahmud, Ayesha S., Marquet, Pablo A., Buckee, Caroline O., Santillana, Mauricio·2021·Science
DOI 10.1126/science.abg5298PMC PMC8158961

Published version of a preprint

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Abstract

Urban socioeconomics and mortality: Santiago, Chile, is a highly segregated city with distinct zones of affluence and deprivation. This setting offers a window on how social factors propel the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic in an economically vulnerable society with high levels of income inequality. Mena et al. analyzed incidence and mortality attributed to SARS-CoV-2 to understand spatial variations in disease burden. Infection fatality rates were higher in lower-income municipalities because of comorbidities and lack of access to health care. Disparities between municipalities in the quality of their health care delivery system became apparent in testing delays and capacity. These indicators explain a large part of the variation in COVID-19 underreporting and deaths and show that these inequalities disproportionately affected younger people. Science , abg5298, this issue p. eabg5298

AI snapshot

Written from the paper’s full text.

TL;DR

In Greater Santiago, Chile, COVID-19 incidence, mortality, testing delays, and infection fatality rates were strongly patterned by municipal socioeconomic status, with lower-SES areas experiencing higher burden and younger-age mortality. The authors link these disparities to mobility constraints, early underreporting, and unequal health care capacity.

Key findings

  • SES ranged from Vitacura (93.7) to La Pintana (17.0). Maximum weekly incidence was 22.6 cases per 10,000 in Vitacura in mid-May versus 76.4 in La Pintana in the first week of June; maximum weekly deaths were 4.4 per 10,000 in San Ramón (SES 19.7) versus 1.6 in Vitacura in June.
  • During full lockdown, the two highest-SES municipalities reduced mobility by up to 61%, whereas lowest-SES municipalities reduced mobility on average to 40%.
  • Observed deaths in May–July 2020 were more than 1.73 times expected (CI 1.68–1.79), peaking above 2110 deaths in epidemiological week 24 versus an expected 802 deaths and an average of 798 deaths between 2015 and 2019. Age-specific observed deaths were nearly twofold higher for people younger than 40, 2.8 times higher for ages 40–60, 3.2 times higher for ages 60–80, and 2.4 times higher for ages 80+.
  • Low- versus high-SES IFR ratios were 1.4 for ages 60–80, 1.7 for ages 40–60, and 3.1 for ages 0–40. Positivity was negatively associated with SES, timeliness was associated with SES, and tests per death were positively associated with SES; South and West zones had four times fewer beds per 10,000 people and four times lower private health system enrollment than the East zone, and more than 90% of COVID-19–attributed deaths in South and West zones occurred outside health care facilities versus 55% in the East zone.

Methods

  • Ecological analysis of 34 municipalities in Greater Santiago, home to almost 7 million people, using SES defined as 100 − the 2019 social priority index (SPI), COVID-19 data from the EPIVIGILA platform, vital statistics mortality data, and Facebook Data for Good mobility data.
  • RmMAP, a Poisson deconvolution model with a quadratic penalty, back-calculated infections from COVID-19–attributed deaths and an onset-to-death distribution; Gaussian process regression estimated excess deaths using 2000–2019 mortality data; a hierarchical Bayesian model inferred CFR/IFR by age and municipality from cases, positivity, deaths, and SES.
  • Analyses related SES to incidence, age-adjusted death rates, mobility, testing positivity, timeliness, and tests per death, and compared IFR ratios across low, mid-low, mid-high, and high SES categories.

Limitations

  • The paper states that mobile phone mobility data are likely biased because of differential mobile phone ownership across demographic groups, though results were consistent with other Santiago studies using different measurements.
  • The paper states that RmMAP estimates rely on the infection-to-death distribution and assume IFRs do not change over time; excess mortality estimates depend on kernel choice; and IFR estimates rely on Bayesian assumptions about reporting rates and age distribution of infections, with sensitivity analyses suggesting stability.
  • Evident from the text: the study is observational and ecological, using municipality-level SES and aggregated data, so it cannot establish causality; age information of reported cases was not available at the municipality level.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1126/science.abg5298

Cites

60 of 60 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 31 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Timeliness follows a similar temporal course as test positivity during May and part of June, but in the opposite direction.

    “As shown in Fig. 4G, timeliness follows a similar temporal course as test positivity during May and part of June, but in the opposite direction.”
    Quote in the paperNot a substantial claim
  • Findingown data

    The 0-40 age group shows IFR values 3.1 times higher for municipalities with lowest SES.

    “The difference is even more pronounced in the younger age group (0 to 40 years old), which shows values of IFR that are 3.1 times higher for the municipalities with the lowest SES.”
    Quote in the paperSubstantial claim
  • Findingown data

    Lower numbers of deaths were reported for influenza and pneumonia, and cancer during July and August 2020 compared with 2015-2019.

    “In addition, lower numbers of deaths were reported for respiratory infectious diseases, such as influenza and pneumonia, and cancer during July and August 2020 compared with the period from 2015 to 2019 (Fig. 3F).”
    Quote in the paperNot a substantial claim
  • Findingown data

    COVID-19-attributed deaths are higher than excess deaths in most municipalities.

    “which also shows COVID-19–attributed deaths higher than the excess deaths in most of the cases.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Disparities between municipalities in the quality of their health care delivery system became apparent in testing delays and capacity.

    “Disparities between municipalities in the quality of their health care delivery system became apparent in testing delays and capacity.”
    Quote in the paperSubstantial claim
  • May combine two claims. 36
  • Classified as probably not a substantial claim. 12

  • May combine two claims.

    Findingown data

    There is a strong negative association between positivity and SES, denoting difficulties in access to health care more pronounced in lower-SES municipalities.

    “A strong negative association between positivity and SES (Fig. 4B) further denotes difficulties in access to health care that is even more pronounced in lower-SES municipalities.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingnone given

    Greater Santiago accounts for 36% of Chile's population but reported 55% of confirmed COVID-19 cases and 65% of COVID-19-attributed deaths before epidemiological week 36.

    “Although this urban center accounts for 36% of the country’s population, it has reported 55% of the confirmed COVID-19 cases and 65% of the COVID-19–attributed deaths before epidemiological week 36 (end of August 2020).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The number of deaths observed between May and July 2020 is more than 1.73 times the expected value (CI 1.68 to 1.79), with a peak surpassing 2110 deaths in week 24 compared with expected 802.

    “As shown in Fig. 3A, the number of deaths observed between May and July 2020 is more than 1.73 (confidence interval 1.68 to 1.79) times the expected value, with a peak surpassing 2110 death counts in epidemiological week 24 (first week of June 2020) compared with an expected value of 802 deaths and an average number of deaths of 798 between 2015 and 2019.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    COVID-19-confirmed deaths follow a similar temporal pattern, and the difference between confirmed and attributed deaths gets smaller toward the end of August, indicative of improved testing capacity.

    “COVID-19–confirmed deaths—those with a polymerase chain reaction (PCR)–confirmed SARS-CoV-2 test—follow a similar temporal pattern, and the difference between confirmed and COVID-19–attributed deaths gets smaller toward the end of August, indicative of an improved testing capacity.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Maximum weekly incidence was 22.6 per 10,000 in Vitacura in mid-May and 76.4 per 10,000 in La Pintana in the first week of June.

    “The maximum incidence in Vitacura was 22.6 weekly cases per 10,000 individuals during the middle of May, whereas La Pintana reported a maximum of 76.4 weekly cases per 10,000 individuals during the first week of June (Fig. 1B).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    SES in Greater Santiago municipalities varies widely, with Vitacura having the highest value (93.7) and La Pintana the lowest (17.0).

    “Socioeconomic status (SES) in the municipalities varies widely, with Vitacura having the highest value (SES = 93.7) and La Pintana the lowest (SES = 17.0; Fig. 1A)”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The highest weekly death rate was 4.4 per 10,000 in San Ramon (SES 19.7), while Vitacura reported a maximum of 1.6 per 10,000 in June.

    “For instance, the highest rate of 4.4 weekly deaths per 10,000 individuals is observed in San Ramon, a municipality with a SES of 19.7, whereas Vitacura reported a maximum of 1.6 weekly deaths per 10,000 in June.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The 60-80 age group had the highest weekly count (936 in week 24), biggest deviation, and highest excess deaths (645 more than expected).

    “the group that contains people between 60 and 80 years old displays the highest weekly count (936 during epidemiological week 24), the biggest deviation from the predicted values, and the highest values of excess deaths (645 more deaths than expected; Fig. 3B).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Timeliness negatively correlates with number of cases, total deaths, and positivity.

    “Timeliness also negatively correlates with the number of cases (Fig. 4I), the total number of deaths (Fig. 4J), and positivity (Fig. 4K).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Positivity significantly correlated with number of cases and number of deaths.

    “Despite changes in positivity rates over time, this testing metric also significantly correlated with the number of cases (Fig. 4C) and number of deaths (Fig. 4D).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The early positive association between tests per capita and SES reversed many months into the epidemic, indicative of improvement in testing capacity over time, so more tests were performed in the most affected areas.

    “Many months into the epidemic, the early positive association between tests per capita and SES (Fig. 2B) reversed (Fig. 4E), indicative of an improvement in testing capacity over time, so that more tests were performed in the most affected areas.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Tests per death positively correlate with SES, indicating testing disparities persisted with low-SES areas most affected.

    “When looking at tests per death, a metric that can be used as a faithful proxy of testing capacity (22), we observe a positive correlation with SES (Fig. 4L), indicating that testing disparities persisted during the epidemic, with low-SES areas being affected the most.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [22] D. K. Kennedy, A. Seale, D. Bausch, “How experts use data to identify emerging COVID-19 success stories,” Our World in Data, 30 June 2020; https://ourworldindata.org/identify-covid-exemplars.

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    People younger than 40 had a nearly twofold increase in total deaths, with a peak 2 weeks earlier than those older than 60.

    “Although people younger than 40 years old have an overall lower mortality rate than those from older age groups as expected, they still exhibit a nearly twofold increase in the total deaths, with a peak in the observed deaths occurring 2 weeks earlier than that for those older than 60 years of age (Fig. 3B).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    An early peak of reported cases was only observed in high-SES municipalities during the middle of March, even though several COVID-19 deaths were reported in low-SES municipalities during the same period.

    “In addition, an early peak of reported cases was only observed in high-SES municipalities during the middle of March (Fig. 2C), even though several COVID-19 deaths, which are lagged with respect to infection by up to several weeks, were reported in low-SES municipalities during the same period.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    For age groups 40-60, 60-80, and 80+, observed deaths were 2.8, 3.2, and 2.4 times higher than expected, respectively.

    “For the age groups 40 to 60, 60 to 80, and older than 80, the observed deaths are 2.8, 3.2, and 2.4 times higher than expected, respectively.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    IFR estimates corrected for underascertainment display a similar pattern to CFR but an order of magnitude lower.

    “Similarly, our resulting IFR estimates once corrected for underascertainment display a similar pattern (Fig. 5B) but on an order of magnitude lower than the CFR estimates.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The number of tests started to positively correlate with deaths, suggesting tests are strong predictors of mortality.

    “Similarly, the number of tests started to positively correlate with deaths (Fig. 4F), suggesting that the number of tests are strong predictors of mortality.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Age groups 60-80 and 40-60 exhibit IFRs 1.4 and 1.7 times higher, respectively, in low-SES compared with high-SES.

    “The age groups 60 to 80 and 40 to 60 exhibit IFRs that are 1.4 and 1.7 times higher, respectively, in the low-SES category compared with the high-SES one.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Anomalies in observed versus predicted deaths across age groups display a significant negative association with SES, except for the 80+ group, suggesting higher death burden in lower-SES municipalities independent of age composition.

    “The anomalies in the observed versus predicted deaths for 2020 across different age groups also display a significant negative association with SES, except for the 80+ group (Fig. 3E), suggesting a higher death burden in lower-SES municipalities, independent of their age composition.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    COVID-19-attributed deaths for Greater Santiago fall within credible intervals of excess deaths until late June, when attributed deaths increase to rates higher than excess deaths, suggesting underreporting in attributed deaths is unlikely.

    “COVID-19–attributed deaths for the entire Greater Santiago area fall withing the credible intervals of excess deaths until late June, when the attributed deaths increase to rates that are even higher than the excess deaths, suggesting that underreporting in COVID-19–attributed deaths is unlikely (Fig. 3C).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Positivity signal tracked the course of the epidemic, peaking at times of highest incidence between May and July, suggesting a highly saturated health care system across the entire city.

    “Our results show that the positivity signal tracked the course of the epidemic, peaking at times of highest incidence between May and July and suggesting a highly saturated health care system during this period across the entire city (Fig. 4A).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    Municipalities with lower SES were less compliant with stay-at-home orders, possibly because people from lower-SES areas are unable to work from home, which leaves them at higher disease risk.

    “First, our analysis of human mobility indicates that municipalities with lower SES were less compliant with stay-at-home orders, possibly because people from lower-SES areas are unable to work from home, which leaves them at a higher disease risk.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Anomalies in overall excess deaths are higher in low-SES areas, particularly in people younger than 80, suggesting more vulnerable municipalities were hit hardest.

    “Third, anomalies in the overall excess deaths are higher in low-SES areas, particularly in people younger than 80 years old, suggesting that more vulnerable municipalities were hit the hardest.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    People in low-SES municipalities are more likely to be overweight and to live in overcrowded conditions, factors that can put these populations at higher disease risk.

    “People in low-SES municipalities are more likely to be overweight and to live in overcrowded conditions (supplementary materials), factors that ultimately can put these populations at higher disease risk.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The South and West zones have four times fewer beds per 10,000 people and four times lower proportion enrolled in the private health system than the East zone, which contains all municipalities with SES of 60 or higher.

    “We also show in the supplementary materials that the South and West zones (based on health coverage division) have four times fewer beds per 10,000 people and four times lower proportion enrolled in the private health system than the East zone, which contains all the municipalities with an SES of 60 or higher.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    More than 90% of COVID-19-attributed deaths in South and West zones occurred in places other than health care facilities, compared with 55% in East zone.

    “Notably, more than 90% of the COVID-19–attributed deaths in the South and West zones occurred in places other than health care facilities, compared with 55% in the East zone.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    Greater Santiago is a highly segregated city with distinct zones of affluence and deprivation.

    “Santiago, Chile, is a highly segregated city with distinct zones of affluence and deprivation.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    A decrease in cancer-attributed deaths can be explained by mortality displacement.

    “A decrease in the number of cancer-attributed deaths can be explained by mortality displacement (19, 20)”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [19] A. Banerjee, L. Pasea, S. Harris, A. Gonzalez-Izquierdo, A. Torralbo, L. Shallcross, M. Noursadeghi, D. Pillay, N. Sebire, C. Holmes, C. Pagel, W. K. Wong, C. Langenberg, B. Williams, S. Denaxas, H. Hemingway, Estimating excess 1-year mortality associated with the COVID-19 pandemic according to underlying conditions and age: A population-based cohort study. Lancet 395, 1715– 1725 (2020). 10.1016/S0140-6736(20)30854-0 32405103 PMC7217641 source

      Not checked in the free run.

    • cites [20] J. M. Aburto, R. Kashyap, J. Schöley, C. Angus, J. Ermisch, M. C. Mills, J. B. Dowd, Estimating the burden of the COVID-19 pandemic on mortality, life expectancy and lifespan inequality in England and Wales: a population-level analysis. J. Epidemiol. Community Health 10.1136/jech-2020-215505 (2021). 10.1136/jech-2020-215505 PMC7818788 33468602 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Infection fatality rates were higher in lower-income municipalities because of comorbidities and lack of access to health care.

    “Infection fatality rates were higher in lower-income municipalities because of comorbidities and lack of access to health care.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    An early first wave of infections occurred during March and quickly spread through the rest of the city without being captured by the official counts.

    “These findings suggest that an early first wave of infections occurred during March and quickly spread through the rest of the city without being captured by the official counts.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The virus was introduced in Chile by travelers from affluent municipalities.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Our results align with recent literature on uneven health risks globally, which has highlighted how socially and economically deprived populations are more vulnerable to the burden of epidemics.

    “Our results align with the recent literature on uneven health risks globally, which has highlighted how socially and economically deprived populations are more vulnerable to the burden of epidemics (24, 25).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [24] O. P. Ottersen, J. Dasgupta, C. Blouin, P. Buss, V. Chongsuvivatwong, J. Frenk, S. Fukuda-Parr, B. P. Gawanas, R. Giacaman, J. Gyapong, J. Leaning, M. Marmot, D. McNeill, G. I. Mongella, N. Moyo, S. Møgedal, A. Ntsaluba, G. Ooms, E. Bjertness, A. L. Lie, S. Moon, S. Roalkvam, K. I. Sandberg, I. B. Scheel, The political origins of health inequity: Prospects for change. Lancet 383, 630– 667 (2014). 10.1016/S0140-6736(13)62407-1 24524782 source

      Not checked in the free run.

    • cites [25] E. R. Meara, S. Richards, D. M. Cutler, The gap gets bigger: Changes in mortality and life expectancy, by education, 1981–2000. Health Aff. (Millwood) 27, 350– 360 (2008). 10.1377/hlthaff.27.2.350 18332489 PMC2366041 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    The lack of association between IFR and SES in the oldest age group can be attributed to lower life expectancy and elderly people being healthier enough to survive until that age.

    “The lack of association between IFR and SES in the oldest age group can be attributed to a lower life expectancy (23), which is factored into the estimation of SES (see methods for details), and the fact that elderly people might be, in general, healthier enough to survive until that age.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [23] U. Bilal, M. Alazraqui, W. T. Caiaffa, N. Lopez-Olmedo, K. Martinez-Folgar, J. J. Miranda, D. A. Rodriguez, A. Vives, A. V. Diez-Roux, Inequalities in life expectancy in six large Latin American cities from the SALURBAL study: An ecological analysis. Lancet Planet. Health 3, e503– e510 (2019). 10.1016/S2542-5196(19)30235-9 31836433 PMC6926471 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The mobility result is consistent with analyses of New York City neighborhoods and with findings from other studies conducted in Santiago that used different socioeconomic and mobility metrics.

    “Our result is consistent with analyses of New York City neighborhoods (11) and with findings from other studies conducted in Santiago that used different socioeconomic and mobility metrics (12–14).”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [11] S. M. Kissler, N. Kishore, M. Prabhu, D. Goffman, Y. Beilin, R. Landau, C. Gyamfi-Bannerman, B. T. Bateman, J. Snyder, A. S. Razavi, D. Katz, J. Gal, A. Bianco, J. Stone, D. Larremore, C. O. Buckee, Y. H. Grad, Reductions in commuting mobility correlate with geographic differences in SARS-CoV-2 prevalence in New York City. Nat. Commun. 11, 4674 (2020). 10.1038/s41467-020-18271-5 32938924 PMC7494926 source

      Not checked in the free run.

    • cites [12] A. Carranza, M. Goic, E. Lara, M. Olivares, G. Y. Weintraub, J. Covarrubia, C. Escobedo, N. Jara, L. J. Basso,The social divide of social distancing: Shelter-in-place behavior in Santiago during the COVID-19 pandemic. SSRN 3691373 [Preprint]. 12 September 2020;. 10.2139/ssrn.3691373 source

      Not checked in the free run.

    • cites [13] M. Bennett, All things equal? Heterogeneity in policy effectiveness against COVID-19 spread in chile. World Dev. 137, 105208 (2021). 10.1016/j.worlddev.2020.105208 32994662 PMC7513907 source

      Not checked in the free run.

    • cites [14] N. Gozzi, M. Tizzoni, M. Chinazzi, L. Ferres, A. Vespignani, N. Perra, Estimating the effect of social inequalities in the mitigation of COVID-19 across communities in Santiago de Chile. Nat. Commun. 12, 2429 (2021). 10.1038/s41467-021-22601-6 33893279 PMC8065143 source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    RmMAP is capable of recovering bimodal phenomena, whereas other methods fail to do so.

    “These experiments confirm that RmMAP is capable of recovering this bimodal phenomena, whereas other methods fail to do so; they oversmooth the true signal, and the earlier peak is typically not recovered.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Age-specific death data may help explain the heterogeneity in COVID-19 burden and COVID-19-attributable deaths in different countries.

    “Age-specific death data may also help explain the heterogeneity in COVID-19 burden and COVID-19–attributable deaths in different countries (9).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [9] M. O’Driscoll, G. Ribeiro Dos Santos, L. Wang, D. A. T. Cummings, A. S. Azman, J. Paireau, A. Fontanet, S. Cauchemez, H. Salje, Age-specific mortality and immunity patterns of SARS-CoV-2. Nature 590, 140– 145 (2021). 10.1038/s41586-020-2918-0 33137809 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    The mortality database is built with death certificates subjected to a rigorous validation process to guarantee the reliability and validity of the information.

    “The mortality database is built with the death certificates, which are subjected to a rigorous validation process, to guarantee the reliability and validity of the information.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Study design and conductnone given

    Mobility data from mobile phones are likely biased due to differential mobile phone ownership across demographic groups.

    “Mobility data from mobile phones are likely to be biased because of differential mobile phone ownership in different demographic groups.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Since March 2020, the DHSI has implemented the World Health Organization recommendations for coding deaths resulting from COVID-19.

    “Since March 2020, the DHSI has implemented the recommendations of the World Health Organization for coding the deaths resulting from COVID-19.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    A higher IFR may reflect limited access to health services during the pandemic, and the strong association between number of tests per death and SES supports this claim.

    “First, a higher IFR may reflect limited access to health services during the pandemic, and the strong association between the number of tests per death and SES supports this claim.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The IFR estimates are derived from a complex Bayesian model and are based on assumptions regarding reporting rates and age distribution of infections.

    “Our IFR estimates are derived from a complex Bayesian model and are based on assumptions regarding reporting rates and age distribution of infections.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Mounting evidence suggests that such differences have also manifested in the context of the COVID-19 pandemic.

    “Mounting evidence suggests that such differences have also manifested in the context of the COVID-19 pandemic (26, 27).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [26] B. Burström, W. Tao, Social determinants of health and inequalities in COVID-19. Eur. J. Public Health 30, 617– 618 (2020). 10.1093/eurpub/ckaa095 32638998 PMC7454505 source

      Not checked in the free run.

    • cites [27] R. Laxminarayan, B. Wahl, S. R. Dudala, K. Gopal, C. Mohan B, S. Neelima, K. S. Jawahar Reddy, J. Radhakrishnan, J. A. Lewnard, Epidemiology and transmission dynamics of COVID-19 in two Indian states. Science 370, 691– 697 (2020). 10.1126/science.abd7672 33154136 PMC7857399 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Because public health measures were taken in response to nominal case counts, these places were underprepared, with a poor health care response that resulted in higher death counts.

    “Because public health measures were taken in response to nominal case counts, these places were underprepared, with a poor health care response that resulted in higher death counts.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    The hierarchical Bayesian framework can borrow from better-known quantities to enhance identification while propagating appropriate uncertainty over parameters.

    “The main appeal of this framework is that although most of the components are not identifiable (e.g., if reporting rates and true cases are both unknown, the same observed case counts can be achieved by multiplying both by the same factor) (37), we can borrow from better-known quantities (e.g., rough estimates of prevalence, reporting, etc.) to enhance identification while propagating the appropri”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [37] G. Papadopoulos, J. Santos Silva, Identification issues in some double-index models for non-negative data. Econ. Lett. 117, 365– 367 (2012). 10.1016/j.econlet.2012.06.001 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    Our results show a strong link between socioeconomic and demographic factors with COVID-19 outcomes and testing capacity in Santiago.

    “Our results show a strong link between socioeconomic and demographic factors with COVID-19 outcomes and testing capacity of COVID-19 in Santiago.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Recent studies in Chile have suggested a link between SES and the effectiveness of nonpharmaceutical interventions such as stay-at-home orders.

    “In Chile, recent studies have suggested a link between SES and the effectiveness of nonpharmaceutical interventions such as stay-at-home orders (12, 13, 29).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [12] A. Carranza, M. Goic, E. Lara, M. Olivares, G. Y. Weintraub, J. Covarrubia, C. Escobedo, N. Jara, L. J. Basso,The social divide of social distancing: Shelter-in-place behavior in Santiago during the COVID-19 pandemic. SSRN 3691373 [Preprint]. 12 September 2020;. 10.2139/ssrn.3691373 source

      Not checked in the free run.

    • cites [13] M. Bennett, All things equal? Heterogeneity in policy effectiveness against COVID-19 spread in chile. World Dev. 137, 105208 (2021). 10.1016/j.worlddev.2020.105208 32994662 PMC7513907 source

      Not checked in the free run.

    • cites [29] Y. Li, E. A. Undurraga, J. R. Zubizarreta, Effectiveness of localized lockdowns in the COVID-19 pandemic. medRxiv 2020.08.25.20182071 [Preprint]. 30 March 2021; 10.1101/2020.08.25.20182071 PMC8807239 35029649 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationnone given

    Our Bayesian method for joint inference of IFRs and underreporting is a new contribution in this field.

    “Our Bayesian method for joint inference of IFRs and underreporting is a new contribution in this field.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisereasoning

    RmMAP overcomes the instability of expectation maximization by adding a quadratic penalty to the log-likelihood.

    “RmMAP overcomes this issue by adding a quadratic penalty to the log-likelihood.”
    Quote in the paperSubstantial claim
47 of 47

  • The paper relies on this without support.

    The characterization of the COVID-19 pandemic in South America has received less attention than in North America, Europe, and parts of Asia.

    “the characterization of the pandemic in South America has received less attention, despite the severe impact in many countries during the Southern Hemisphere winter season.”

  • The paper relies on this without support.

    Chile set up a notably thorough reporting system and made many key datasets publicly available.

    “Unlike many other countries, Chile set up a notably thorough reporting system and made many key datasets publicly available.”

  • The paper relies on this without support.

    The pathways modulating differential COVID-19 outcomes by socioeconomic status are not well understood.

    “Because the pathways modulating these differential outcomes are not well understood, comprehensive accounts are urgently needed (28)”

  • The paper relies on this without support.

    Human mobility indicators inferred from anonymized mobile phone data are a valid proxy for physical distancing.

    “Changes in human mobility—a proxy for physical distancing—during lockdown periods follow a similar trend.”

  • The paper relies on this without support.

    The virus was introduced in Chile by travelers from affluent municipalities.

    “the month in which the virus was introduced in Chile by travelers from affluent municipalities.”

  • The authors state this as an assumption.

    The infection fatality rates (IFRs) do not change over time.

    “assume that the IFRs do not change over time”

  • The authors state this as an assumption.

    There exists an underlying municipality-specific proportion infected pm such that within each age group the number of infected people is on average pm × Pm,a.

    “An implicit assumption in Eq. 8 is the existence of an underlying municipality-specific proportion infected pm so that on each age group, the number of infected people is (on average) pm×Pm,a.”

  • The authors state this as an assumption.

    The logit of the municipality-specific proportion infected pm follows logit(pm) = p0 + μm.

    “We also assumed the following relation for pm:logitpm=p0+μm(9)”
8 of 8

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Individuals living in higher income sub-city units were the first to adopt social technologies that prevent the spread of COVID-19, such as remote work, reducing social contact, the use of masks, and the active use of rapid and molecular testing.

    “Individuals living in higher income sub-city units were the first to adopt social technologies that prevent the spread of COVID-19, such as remote work, reducing social contact, the use of masks, and the active use of rapid and molecular testing to know whether they had contracted COVID-19 and subsequently take appropriate precautions [54].”

    From Social epidemiology of urban COVID-19 inequalities in Latin America and Canada (2024) · cites this paper as [54]

    The ‘Association between socioeconomic status and disease dynamics’ section reports larger reductions in mobility in higher-SES municipalities, and ‘Epidemic reconstruction reveals early transmission dynamics’ reports more tests there early in the outbreak (pages not provided). The paper suggests that lower-SES residents may have been unable to work from home, but it does not establish that individuals in wealthier areas were first to adopt these measures, nor does it document mask use, rapid or molecular test types, or testing undertaken to guide personal precautions. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Prior work has shown important disparities in COVID-19 impact by race/ethnicity and economic status in the US and abroad.

    “Prior work has shown important disparities in COVID-19 impact by race/ethnicity and economic status (Mena et al., 2021; Rossen, 2021) in the US and abroad.”

    From Direct and indirect mortality impacts of the COVID-19 pandemic in the United States, March 1, 2020 to January 1, 2022 (2023) · cites this paper as Mena et al., 2021

Cites

Flagged first, then by citations

3 of the 63 references couldn’t be matched to a known paper.

Research works printed but not linked: 6

  1. C. K. Williams C. E. Rasmussen Gaussian Processes for Machine Learning (MIT Press 2006) vol. 2.
  2. P. Maas et al . in Proceedings of the 16th International Conference on Information Systems for Crisis Response and Management València Spain May 19-22 2019 (ISCRAM Association 2019) vol. 19 p. 3173.
  3. R. L. White in Instrumentation in Astronomy VIII D. L. Crawford E. R. Craine Eds. (International Society for Optics and Photonics 1994) vol. 2198 pp. 1342–1348.
  4. M. Titsias in Proceedings of the Twelfth International Conference on Artificial Intelligence and Statistics D. van Dyk M. Welling Eds. vol. 5 of Proceedings of Machine Learning Research (PMLR 2009) pp. 567–574.
  5. M. Plummer et al . in Proceedings of the 3rd International Workshop on Distributed Statistical Computing (Vienna Austria 2003) vol. 124 pp. 1–10.
  6. A. Wilson R. Adams in Proceedings of the 30th International Conference on Machine Learning (PMLR 2013) pp. 1067–1075.

Cited by

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Related

Authors
Mena, G. E., Martinez, P. P., Mahmud, A. S., Marquet, P. A., Buckee, C. O., & Santillana, M.
Affiliations
  • University of Oxford (GB)
  • Harvard University (US)
  • Santa Fe Institute (US)
  • Boston Children's Hospital (US)
Corresponding author
  • Mena, Gonzalo E.
  • Martinez, Pamela P.
  • Buckee, Caroline O.
  • Santillana, Mauricio
ORCID
Venue
Science
Publisher
American Association for the Advancement of Science (AAAS)
Published
2021-05-28
Volume
372
Issue
6545
ISSN
  • 0036-8075 (ISSN-L)
  • 1095-9203
DOI
10.1126/science.abg5298
PMC
PMC8158961
OpenAlex
W3157070895
Semantic Scholar
ada3e63fed56d86915c6f157205a2512c640b817
Cited by
431
References
63
Citations by year
2026: 19 · 2025: 40 · 2024: 82 · 2023: 110 · 2022: 116 · 2021: 63
FWCI
35.86
Type
journal article
Language
en
Open access
Licence
Locations
  • Science (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health (U54GM088558)
  • National Institute of General Medical Sciences (R01 GM130668)
  • Teikyo University School of Medicine (U54GM088558, R01GM130668)
  • Harvard Data Science Initiative
  • Schmidt futures award
Topics
  • Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
  • Social Sciences › Health › Public Health and Social Inequalities
  • Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
Keywords
COVID-19 pandemic, socioeconomic status, socioeconomic inequalities in health, COVID-19 mortality, excess mortality, infection fatality rate, COVID-19 incidence, public health capacity, youth, Santiago de Chile
MeSH terms
Physical Distancing, COVID-19, COVID-19 Nucleic Acid Testing, Adult, Age Factors, Aged, Chile, Cities, Humans, Middle Aged, Mortality, Poverty, Social Class, Socioeconomic Factors, Urban Health, Incidence

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

Statistics and arithmetic are recomputed, not judged.

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