Social cohesion and COVID-19 mortality in different periods of the pandemic: variable efficacy of trust in civil services.

Abstract

Aims: Social cohesion has been reported to influence various health outcomes positively. However, inconsistent results were reported regarding the effects of social cohesion dimensions on the COVID-19 mortality rate (MR). Most studies have indicated that trust in civil services but not participating in social activities reduces COVID-19 mortality, possibly because of the highly contagious nature of this disease. In this study, we investigated how the effects of various dimensions of social cohesion on COVID-19 MR vary across different phases of the pandemic.

Methods: This study used data from 86 countries participating in the 2017-2020 World Values Survey. The measures of social cohesion were identified by aggregating responses to the country level. COVID-19 MR was calculated-using data from the European Centre for Disease Prevention and Control-separately for three distinct periods during the pandemic: 13 January 2020-8 November 2020; 9 November 2020-5 September 2021; and 6 September 2021-20 June 2022. An exploratory factor analysis (EFA) was conducted to identify the dimensions of social cohesion, and negative binomial regression models were constructed to analyze data for each period.

Results: The EFA results revealed three dimensions of social cohesion: social participation and inclusion, health service equality, and trust in civil services and democracy. COVID-19 MR was negatively associated with trust in civil services and democracy during the early two periods and with social participation and inclusion during the late period.

Conclusions: Each social cohesion dimension uniquely contributed to reducing the COVID-19 MR in different pandemic periods.