Gini coefficient, GDP per capita and COVID-19 mortality: a systematic review of ecologic studies

Abstract Background Since December 2019, when Wuhan officially reported COVID-19, the disease has spread globally, revealing significant variations in mortality rates influenced by socio-economic factors and health policies. This study aims to identify two predictors of COVID-19 mortality difference...

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Main Authors: Amir Farhang Abbasi, Negin Karimi Dehkordi, Neda SoleimanvandiAzar, Mahshid Roohravan Benis, Marzieh Nojomi
Format: Article
Language:English
Published: BMC 2025-05-01
Series:BMC Public Health
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Online Access:https://doi.org/10.1186/s12889-025-22921-y
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Summary:Abstract Background Since December 2019, when Wuhan officially reported COVID-19, the disease has spread globally, revealing significant variations in mortality rates influenced by socio-economic factors and health policies. This study aims to identify two predictors of COVID-19 mortality differences—GDP (Gross Domestic Product), and Gini Coefficient index—across various countries through a systematic review. Methods The study was a systematic review conducted according to PRISMA guidelines. The search strategy was searched in the titles and abstracts of the articles in three main databases: PubMed, Scopus, and Web of Science. Gini Coefficients and the Gross Domestic Product (GDP) of the countries were used as mortality predictors. The initial search yielded 331 articles, which were assessed for quality using the Newcastle Ottawa Scale (NOS). Ultimately, 31 articles were included in the final synthesis. Results Most studies analyzed data from multiple countries, with only ten of the thirty-one articles focusing on a single nation. Initial research in 2020 aimed to understand the immediate socioeconomic factors affecting COVID-19 outcomes. Later studies in 2021 and 2022 explored more complex interactions between the pandemic and socioeconomic factors, while long-term outcomes were published in 2023 and 2024. Some studies found a paradoxical relationship between GDP and COVID-19 mortality rates, whereas most indicated a positive correlation between COVID-19 mortality rates and the Gini index. Conclusion Both income inequality and GDP significantly influence COVID-19 mortality rates. While a higher GDP can provide some protective benefits, it does not completely shield countries from high mortality, especially when considering economic activity and demographics. Researchers consistently identify income inequality as a predictor of poorer health outcomes, highlighting the need for equitable health and social policies to mitigate vulnerabilities in future pandemics.
ISSN:1471-2458