Higher COVID-19 mortality in low-income communities in the City of Cape Town – a descriptive ecological study
Open accessAbstract
Background Cape Town, a South African city with high levels of economic inequality, has gone through two COVID-19 waves. There is evidence globally that low-income communities experience higher levels of morbidity and mortality during the pandemic. Methods Age-standardized COVID-19 mortality in the eight sub-districts of Cape Town was compared by economic indicators taken from the most recent Census (unemployment rate, monthly income). Results The overall Standardized Death Rate (SDR) for COVID-19 in Cape Town was 1 640 per million, but there was wide variation across the different sub-districts. A linear relationship was seen between sub-districts with high poverty and high COVID-19 SDRs. Conclusions Low-income communities in Cape Town experienced higher levels of COVID-19 mortality. As we continue to contend with COVID-19, these communities need to be prioritized for access to quality health care.
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Social inequalities in COVID-19 deaths were evident during the early pandemic period across the world.
“Social inequalities in COVID-19 deaths were evident during the early pandemic period across the world(2-8).”
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Cites
High-quality health systems in the Sustainable Development Goals era: time for a revolution
Kruk, M. E., Gage, A. D., Arsenault, C., Jordan, K., Leslie, H. H., Roder-DeWan, S., Adeyi, O., Barker, P., Daelmans, B., Doubova, S. V., et al. (2018) · The Lancet Global Health · doi:10.1016/s2214-109x(18)30386-3 · Cited by 4,057 · see citing works
Tegally, H., Wilkinson, E., Giovanetti, M., Iranzadeh, A., Fonseca, V., Giandhari, J., Doolabh, D., Pillay, S., San, E. J., Msomi, N., et al. (2020) · doi:10.1101/2020.12.21.20248640 · Cited by 2,535 · see citing works
Self-citationDetection of a SARS-CoV-2 variant of concern in South Africa
Tegally, H., Wilkinson, E., Giovanetti, M., Iranzadeh, A., Fonseca, V., Giandhari, J., Doolabh, D., Pillay, S., San, E. J., Msomi, N., et al. (2021) · Nature · doi:10.1038/s41586-021-03402-9 · Cited by 2,510 · see citing works
Self-citationEscape of SARS-CoV-2 501Y.V2 from neutralization by convalescent plasma
Cele, S., Gazy, I., Jackson, L., Hwa, S.-H., Tegally, H., Lustig, G., Giandhari, J., Pillay, S., Wilkinson, E., Naidoo, Y., et al. (2021) · doi:10.1101/2021.01.26.21250224 · Cited by 651 · cited 1× · see citing works
“However, the science on re-infection is still very unclear, and particularly in the context of emerging variants, this should be interpreted cautiously 23 .”
BackgroundEscape of SARS-CoV-2 501Y.V2 from neutralization by convalescent plasma
Network for Genomic Surveillance in South Africa, Cele, S., COMMIT-KZN Team, Gazy, I., Jackson, L., Hwa, S.-H., Tegally, H., Lustig, G., Giandhari, J., Pillay, S., et al. (2021) · Nature · doi:10.1038/s41586-021-03471-w · Cited by 651 · see citing works
Boulle, A., Davies, M., Hussey, H. S., Ismail, M., Morden, E., Vundle, Z., Zweigenthal, V., Mahomed, H., Paleker, M., Pienaar, D. C., et al. (2020) · Clinical Infectious Diseases · doi:10.1093/cid/ciaa1198 · Cited by 591 · see citing works
Self-citationAssociation of Social and Demographic Factors with COVID-19 Incidence and Death Rates in the US
Karmakar, M., Lantz, P. M., & Tipirneni, R. (2021) · JAMA Network Open · doi:10.1001/jamanetworkopen.2020.36462 · Cited by 580 · see citing works
COVID-19 pandemic and the social determinants of health
Paremoer, L., Nandi, S., Serag, H., & Baum, F. (2021) · BMJ · doi:10.1136/bmj.n129 · Cited by 553 · cited 1× · see citing works
“The COVID-19 pandemic has exposed the longstanding structural drivers of health inequities globally 25 .”
BackgroundBhaskaran, K., Rentsch, C. T., MacKenna, B., Schultze, A., Mehrkar, A., Bates, C. J., Eggo, R. M., Morton, C. E., Bacon, S., Inglesby, P., et al. (2020) · The Lancet HIV · doi:10.1016/s2352-3018(20)30305-2 · Cited by 464 · see citing works
Racial Disparities in Incidence and Outcomes Among Patients With COVID-19
Munoz-Price, L. S., Nattinger, A. B., Rivera‐Buendía, F., Hanson, R., Gmehlin, C. G., Perez, A., Singh, S., Buchan, B. W., Ledeboer, N. A., & Pezzin, L. E. (2020) · JAMA Network Open · doi:10.1001/jamanetworkopen.2020.21892 · Cited by 358 · see citing works
Sulla, V., & Zikhali, P. (2018) · Cited by 295 · see citing works
Jassat, W., Mudara, C., Ozougwu, L., Tempia, S., Blumberg, L. H., Davies, M., Pillay, Y. G., Carter, T., Morewane, R., Wolmarans, M., et al. (2021) · The Lancet Global Health · doi:10.1016/s2214-109x(21)00289-8 · Cited by 190 · see citing works
Self-citationData Centre Profile: The Provincial Health Data Centre of the Western Cape Province, South Africa
Boulle, A., Heekes, A., Tiffin, N., Smith, M., Mutemaringa, T., Zinyakatira, N., Phelanyane, F., Pienaar, C., Buddiga, K., Coetzee, E., et al. (2019) · International Journal for Population Data Science · doi:10.23889/ijpds.v4i2.1143 · Cited by 149 · see citing works
Self-citationNwosu, C. O., & Oyenubi, A. (2021) · International Journal for Equity in Health · doi:10.1186/s12939-020-01361-7 · Cited by 119 · see citing works
Martins-Filho, P. R., de Souza Araújo, A. A., Quintans-Júnior, L. J., & Santos, V. S. (2020) · Journal of Travel Medicine · doi:10.1093/jtm/taaa128 · Cited by 72 · see citing works
Shaw, J. A., Meiring, M., Cummins, T., Chegou, N. N., Claassen, C., du Plessis, N., Flinn, M., Hiemstra, A. M., Kleynhans, L., Leukes, V., et al. (2021) · PLoS ONE · doi:10.1371/journal.pone.0247852 · Cited by 64 · see citing works
Jassat, W., Mudara, C., Ozougwu, L., Tempia, S., Blumberg, L. H., Davies, M., Pillay, Y. G., Carter, T., Morewane, R., Wolmarans, M., et al. (2021) · medRxiv · doi:10.1101/2021.03.09.21253184 · Cited by 61 · see citing works
Self-citationSykes, W., Mhlanga, L., Swanevelder, R., Glatt, T. N., Grebe, E., Coleman, C., Pieterson, N., Cable, R., Welte, A., van den Berg, K., et al. (2021) · Research Square · doi:10.21203/rs.3.rs-233375/v1 · Cited by 59 · see citing works
Poverty and survival from COVID-19 in Mexico
Millán-Guerrero, R. O., Caballero-Hoyos, R., & Monárrez‐Espino, J. (2020) · Journal of Public Health · doi:10.1093/pubmed/fdaa228 · Cited by 41 · see citing works
Younger ages at risk of Covid-19 mortality in communities of color
Klugman, K. P., Zewdu, S., Mahon, B. E., Dowell, S. F., Srikantiah, P., Laserson, K. F., Tappero, J. W., Zaidi, A. K. M., & Mundel, T. (2020) · Gates Open Research · doi:10.12688/gatesopenres.13151.1 · Cited by 20 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- [11]Western Cape Government - Health: Western Cape Burden of Disease - Rapid Review Update 2019. 2020. Reference Source
Cited by
Sorted by citations
COVID-19 mortality and deprivation: pandemic, syndemic, and endemic health inequalities
McGowan, V. J., & Bambra, C. L. (2022) · The Lancet Public Health · doi:10.1016/s2468-2667(22)00223-7 · Cited by 302 · see citing works
Davies, M., Kassanjee, R., Rousseau, P., Morden, E., Johnson, L. F., Solomon, W., Hsiao, M., Hussey, H. S., Meintjes, G., Paleker, M., et al. (2022) · Tropical Medicine & International Health · doi:10.1111/tmi.13752 · Cited by 134 · see citing works
Self-citationArantes, M. A. F., Conegundes, A. F., Miranda, B. C. B., Campos, A. S. R. R., Vieira, A. L. F., Faleiro, M. D., Campos, M. A., Kroon, E. G., & Bentes, A. A. (2023) · Reviews in Medical Virology · doi:10.1002/rmv.2432 · Cited by 26 · see citing works
Kassanjee, R., Davies, M., Ngwenya, O., Osei‐Yeboah, R., Jacobs, T., Morden, E., Timmerman, V., Britz, S., Mendelson, M., Taljaard, J., et al. (2023) · Journal of the International AIDS Society · doi:10.1002/jia2.26104 · Cited by 17 · see citing works
Self-citationEike, D., Hogrebe, M., Kifle, D., Tregilgas, M., Uppal, A., & Calmy, A. (2022) · Epidemiologia · doi:10.3390/epidemiologia3020023 · Cited by 16 · see citing works
Lambarey, H., Blumenthal, M. J., Chetram, A., Joyimbana, W., Jennings, L., Tincho, M. B., Burgers, W. A., Orrell, C., & Schäfer, G. (2022) · Viruses · doi:10.3390/v14061222 · Cited by 14 · see citing works
Dumalanède, C., Ciambotti, G., & Lashitew, A. A. (2024) · Business & Society · doi:10.1177/00076503241255479 · Cited by 6 · see citing works
Wang, Z., Lu, Z., Ma, J., Huang, G., & An, C. (2024) · Ocean & Coastal Management · doi:10.1016/j.ocecoaman.2024.107434 · Cited by 6 · see citing works
A Global Meta‐Analysis of the Effects of Greenspaces on COVID‐19 Infection and Mortality Rates
Phogole, B., & Yessoufou, K. (2024) · GeoHealth · doi:10.1029/2024gh001110 · Cited by 6 · see citing works
Wang, L., Swayze, S., Bodner, K., Calzavara, A., Harrigan, S. P., Siddiqi, A., Baral, S. D., Austin, P. C., Smylie, J., Koh, M., et al. (2026) · American Journal of Epidemiology · doi:10.1093/aje/kwaf051 · Cited by 5 · see citing works
Phogole, B., & Yessoufou, K. (2023) · Sustainability · doi:10.3390/su151914508 · Cited by 5 · see citing works
Hussey, H. S., Vreede, H., Davies, M., Heekes, A., Kalk, E., Hardie, D. R., van Zyl, G. U., Naidoo, M., Morden, E., Bam, J., et al. (2024) · PLOS Global Public Health · doi:10.1371/journal.pgph.0003554 · Cited by 5 · see citing works
Self-citationMathebula, L., Wiysonge, C. S., & Cooper, S. (2026) · Vaccines · doi:10.3390/vaccines14040320 · Cited by 4 · see citing works
Cardozo, O. I. M., Bedoya, J. P. P., Galvis, L. M. R., Aguirre, C. A. P., Rodríguez, B. A., Barengo, N. C., Jiménez, J. C., & Valencia, P. A. D. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1139379 · Cited by 3 · see citing works
Chronic Poverty Report 5 - Pandemic Poverty
Shepherd, A., & Diwakar, V. (2023) · doi:10.19088/cc.2023.006 · Cited by 3 · see citing works
Mathebula, L., Wiysonge, C. S., & Zunza, M. (2026) · Vaccine · doi:10.1016/j.vaccine.2026.128730 · Cited by 2 · see citing works
Mawoyo, T. L., Roberts, K. J. S., Laurenzi, C. A., Skeen, S., Toit, S. D., Hisham, R., Cluver, L. D., Sherr, L., & Tomlinson, M. (2024) · AIDS Care · doi:10.1080/09540121.2024.2333435 · Cited by 2 · see citing works
COVID-19: Work, Economic Activity and the Spatiotemporal Distribution of Infection in South Africa
Ntatamala, I., Naidoo, R. N., Ncayiyana, J. R., & Jeebhay, M. F. (2022) · Springer eBooks · doi:10.1007/978-3-031-09432-3_13 · Cited by 1 · see citing works
Bibliography, Chronic Poverty Report 5 - Pandemic Poverty
Shepherd, A., & Diwakar, V. (2023) · doi:10.19088/cpan.2023.022
Mametja, S., Shapiro, D., Semenya, M., Hattingh, J., Kantor, G. S. A., Cohen, C., Jassat, W., Getz, C., Moloabi, S., & Tempia, S. (2022) · South African Health Review · doi:10.61473/001c.75271
Azubuike, S. O. (2025) · Journal of Interventional Epidemiology and Public Health · doi:10.37432/jieph-d-24-02028
Fonka, C. B., Khamisa, N., Worku, E. B., & Blaauw, D. (2025) · BMJ Open · doi:10.1136/bmjopen-2024-097820
Greyling, S., & Morden, E. (2026) · City Culture and Society · doi:10.1016/j.ccs.2026.100742
Self-citationOldfield, S., & Greyling, S. (2026) · Urban Geography · doi:10.1080/02723638.2026.2727115
- Authors
- Hussey, H., Zinyakatira, N., Morden, E., Ismail, M., Paleker, M., Bam, J.-L., London, L., Boulle, A., & Davies, M.-A.
- Affiliations
- Western Cape Department of Health (ZA)
- University of Cape Town (ZA)
- Corresponding author
- Hussey, Hannah
- ORCID
- Venue
- Gates Open Research
- Publisher
- F1000 Research Ltd
- Published
- 2021-06-04
- Volume
- 5
- Pages
- 90
- ISSN
- 2572-4754 (ISSN-L)
- PMC
- PMC8264385
- OpenAlex
- W3170377122
- Cited by
- 27
- References
- 17
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 5 · 2023: 7 · 2022: 8
- FWCI
- 1.93
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Gates Open Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Bill and Melinda Gates Foundation (1164272, 119327)
- Topics
- Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
- Social Sciences › Health › Health disparities and outcomes
- Social Sciences › Health › Public Health and Social Inequalities
- Keywords
- COVID-19 mortality, low-income communities, socioeconomic disparities, poverty, unemployment, income, age-standardized mortality rates, health equity, Cape Town
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