The impact of contextual socioeconomic and demographic characteristics of residents on COVID-19 outcomes during public health restrictions in Sydney, Australia

Maria Gabriela Uribe Guajardo; Corey Moore; Vicki Giannopoulos; Hueiming Liu; Amber Tickle; Pejman Adily; Ferdinand C Mukumbang; Emma Quinn; Michelle Cunich; Ilan Katz; Andrew Page; Susan Wolfenden; James Gillespie; Paul Haber; Andrew Wilson; Leena Gupta; John Eastwood; Carmen Huckel Schneider

doi:10.1016/j.anzjph.2025.100228

The impact of contextual socioeconomic and demographic characteristics of residents on COVID-19 outcomes during public health restrictions in Sydney, Australia

Aust N Z J Public Health. 2025 Apr;49(2):100228. doi: 10.1016/j.anzjph.2025.100228. Epub 2025 Mar 6.

Authors

Maria Gabriela Uribe Guajardo¹, Corey Moore², Vicki Giannopoulos³, Hueiming Liu⁴, Amber Tickle⁵, Pejman Adily⁶, Ferdinand C Mukumbang⁷, Emma Quinn⁸, Michelle Cunich⁹, Ilan Katz¹⁰, Andrew Page¹¹, Susan Wolfenden¹², James Gillespie¹³, Paul Haber³, Andrew Wilson¹³, Leena Gupta¹⁴, John Eastwood¹⁵, Carmen Huckel Schneider¹³

Affiliations

¹ Menzies Centre for Health Policy and Economics, Sydney School of Public Health, University of Sydney, Sydney, Australia; Sydney Institute for Women, Children and their Families, Sydney Local Health District, Sydney, Australia. Electronic address: gabriela.uribe@sydney.edu.au.
² Menzies Centre for Health Policy and Economics, Sydney School of Public Health, University of Sydney, Sydney, Australia; Sydney Institute for Women, Children and their Families, Sydney Local Health District, Sydney, Australia; Public Health Unit, Nepean Blue Mountains Local Health District, Sydney, Australia; Public Health Unit, Sydney Local Health District, New South Wales, Sydney, Australia; Clinical Services Integration and Population Health, Sydney Local Health District, Sydney, NSW, 2050, Australia; Ingham Institute for Applied Medical Research, Sydney, Australia.
³ Edith Collins Centre, Drug Health Services, Sydney Local Health District, Camperdown, Australia.
⁴ Sydney Institute for Women, Children and their Families, Sydney Local Health District, Sydney, Australia; George Institute, University of New South Wales, Sydney, Australia.
⁵ Sydney Institute for Women, Children and their Families, Sydney Local Health District, Sydney, Australia; Public Health Unit, Sydney Local Health District, New South Wales, Sydney, Australia; Clinical Services Integration and Population Health, Sydney Local Health District, Sydney, NSW, 2050, Australia.
⁶ Sydney Institute for Women, Children and their Families, Sydney Local Health District, Sydney, Australia; Ingham Institute for Applied Medical Research, Sydney, Australia.
⁷ Clinical Services Integration and Population Health, Sydney Local Health District, Sydney, NSW, 2050, Australia; Ingham Institute for Applied Medical Research, Sydney, Australia; School of Global Health, University of Washington, Seattle, Washington, United States.
⁸ Health Protection New South Wales, Ministry of Health, Sydney Australia; School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
⁹ Boden Initiative, Charles Perkins Centre, Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Sydney Health Economics Collaborative, Sydney Local Health District (SLHD), Sydney, New South Wales, Sydney, Australia.
¹⁰ Social Policy Research Centre, University of New South Wales, Australia.
¹¹ Translation Health Research Institute, Western Sydney University, Sydney, Australia.
¹² Sydney Institute for Women, Children and their Families, Sydney Local Health District, Sydney, Australia; Population Child Health Research Group, University of New South Wales, Sydney, Australia.
¹³ Menzies Centre for Health Policy and Economics, Sydney School of Public Health, University of Sydney, Sydney, Australia.
¹⁴ Public Health Unit, Sydney Local Health District, New South Wales, Sydney, Australia.
¹⁵ Sydney Institute for Women, Children and their Families, Sydney Local Health District, Sydney, Australia; Clinical Services Integration and Population Health, Sydney Local Health District, Sydney, NSW, 2050, Australia; Sydney Local Health District, Sydney, Australia.

PMID: 40054327
DOI: 10.1016/j.anzjph.2025.100228

Abstract

Objective: To investigate the impact of contextual socioeconomic and demographic characteristics of residents on COVID-19 outcomes during public health measures.

Methods: Aggregated data from the NSW Notifiable Conditions Information Management System linked to Australian Census data, by periods of strict and relaxed measures, were used.

Results: During strict measures, residents of areas of lower socioeconomic status (SES) had a higher risk of infection, with the lowest areas having greater risk compared with the highest areas ((hazard ratio (HR)) 7.15, 95% confidence interval (CI) 6.24-8.19). The risk of infection was lower for those aged 40 and over and was higher for males (HR 1.34, 95% CI 1.27-1.40); those in living in areas with larger household sizes (HR 1.56, 95% CI 36-1.78); and individuals in areas with a large proportion of residents born in South Asia (HR 1.18; 95% CI 1.07-1.29), South East Asia (HR 1.20, 95% CI 1.07-1.36) and the Middle East and North Africa (HR 1.67, 95% CI 1.47-1.90). During relaxed restrictions, the impact of variables attenuated but remained significant.

Conclusions: Minorities, those residing in lower SES areas and those living in larger households had worse COVID-19 outcomes during strict public health measures.

Implications for public health: Decision-makers should tailor services to avoid inequities.

Keywords: COVID-19 outcomes; Sydney; public health responses; socioeconomic status.

MeSH terms

Adolescent
Adult
Aged
Australia / epidemiology
COVID-19* / epidemiology
COVID-19* / prevention & control
Demography
Female
Humans
Male
Middle Aged
New South Wales / epidemiology
Public Health*
Residence Characteristics
SARS-CoV-2
Social Class
Sociodemographic Factors
Socioeconomic Factors
Young Adult