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We anticipated that people in rural areas and small towns with lower population density, lower connectivity and jobs less dependent on social interaction will be less exposed to COVID-19. Still, other variables correlated with socioeconomic inequalities may have a greater impact on transmission.


We investigated how COVID-19 affected rural and urban communities in Poland, focussing on the most exposed groups and disparities in SARS-CoV-2 transmission.


A random digit dial sample of Polish adults stratified by region and age was drawn from 29 March to 14 May 2021. Serum samples were tested for anti-S1 and anti-N IgG antibodies, and positive results in both assays were considered indicative of past infection. Seroprevalence estimates were weighted to account for non-response. Adjusted odds ratios (AORs) were calculated using multivariable logistic regression.


There was serological evidence of infection in 32.2% (95% CI: 30.2–34.4) of adults in rural areas/small towns (< 50,000 population) and 26.6% (95% CI: 24.9–28.3) in larger cities. Regional SARS-CoV-2 seroprevalence ranged from 23.4% (95% CI: 18.3–29.5) to 41.0% (95% CI: 33.5–49.0) and was moderately positively correlated (R = 0.588; p = 0.017; n = 16) with the proportion of respondents living in rural areas or small cities. Upon multivariable adjustment, both men (AOR = 1.60; 95% CI: 1.09–2.35) and women (AOR = 2.26; 95% CI: 1.58–3.21) from these areas were more likely to be seropositive than residents of larger cities.


We found an inverse urban–rural gradient of SARS-CoV-2 infections during early stages of the COVID-19 pandemic in Poland and suggest that vulnerabilities of populations living in rural areas need to be addressed.


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  1. Ismail SJ, Tunis MC, Zhao L, Quach C. Navigating inequities: a roadmap out of the pandemic. BMJ Glob Health. 2021;6(1):e004087.  https://doi.org/10.1136/bmjgh-2020-004087  PMID: 33479019 
  2. Alidadi M, Sharifi A. Effects of the built environment and human factors on the spread of COVID-19: A systematic literature review. Sci Total Environ. 2022;850:158056.  https://doi.org/10.1016/j.scitotenv.2022.158056  PMID: 35985590 
  3. Lewis NM, Friedrichs M, Wagstaff S, Sage K, LaCross N, Bui D, et al. Disparities in COVID-19 incidence, hospitalizations, and testing, by area-level deprivation - Utah, March 3-July 9, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(38):1369-73.  https://doi.org/10.15585/mmwr.mm6938a4  PMID: 32970656 
  4. Peters DJ. Community susceptibility and resiliency to COVID-19 across the rural-urban continuum in the United States. J Rural Health. 2020;36(3):446-56.  https://doi.org/10.1111/jrh.12477  PMID: 32543751 
  5. Wells K, Lurgi M, Collins B, Lucini B, Kao RR, Lloyd AL, et al. Disease control across urban-rural gradients. J R Soc Interface. 2020;17(173):20200775.  https://doi.org/10.1098/rsif.2020.0775  PMID: 33292095 
  6. Tselios V. Urbanization and socioeconomic status in the European Regions: The role of population ageing and capital city regions. Eur Plann Stud. 2014;22(9):1879-901.  https://doi.org/10.1080/09654313.2013.812063 
  7. Cuadros DF, Branscum AJ, Mukandavire Z, Miller FD, MacKinnon N. Dynamics of the COVID-19 epidemic in urban and rural areas in the United States. Ann Epidemiol. 2021;59:16-20.  https://doi.org/10.1016/j.annepidem.2021.04.007  PMID: 33894385 
  8. Brauner JM, Mindermann S, Sharma M, Johnston D, Salvatier J, Gavenčiak T, et al. Inferring the effectiveness of government interventions against COVID-19. Science. 2021;371(6531):eabd9338.  https://doi.org/10.1126/science.abd9338  PMID: 33323424 
  9. European Centre for Disease Prevention and Control (ECDC). Data on the weekly subnational 14-day notification rate of new COVID-19 cases. Stockholm: ECDC; 2022. Available from: https://www.ecdc.europa.eu/en/publications-data/weekly-subnational-14-day-notification-rate-covid-19
  10. Barber RM, Sorensen RJD, Pigott DM, Bisignano C, Carter A, Amlag JO, et al. Estimating global, regional, and national daily and cumulative infections with SARS-CoV-2 through Nov 14, 2021: a statistical analysis. Lancet. 2022;399(10344):2351-80.  https://doi.org/10.1016/S0140-6736(22)00484-6  PMID: 35405084 
  11. Piasecki T, Mucha PB, Rosińska M. On limits of contact tracing in epidemic control. PLoS One. 2021;16(8):e0256180.  https://doi.org/10.1371/journal.pone.0256180  PMID: 34407137 
  12. Rosińska M, Stępień M, Kitowska W, Milczarek M, Juszczyk G, Nowacka Z, et al. Healthcare workers highly affected during the COVID-19 epidemic wave in Poland prior to vaccination availability: seroprevalence study. Med Pr. 2022;73(2):109-23.  https://doi.org/10.13075/mp.5893.01216  PMID: 35301511 
  13. Grabowski J, Witkowska N, Bidzan L. Letter to the editor: Excess all-cause mortality during second wave of COVID-19 - the Polish perspective. Euro Surveill. 2021;26(7):2100117.  https://doi.org/10.2807/1560-7917.ES.2021.26.7.2100117  PMID: 33602384 
  14. World Health Organization (WHO). Population-based age-stratified seroepidemiological investigation protocol for coronavirus 2019 (COVID-19) infection, 26 May 2020, version 2. Geneva: WHO; 2020. Available from: https://apps.who.int/iris/handle/10665/332188
  15. Leclercq V, Van den Houte N, Gisle L, Roukaerts I, Barbezange C, Desombere I, et al. Prevalence of anti-SARS-CoV-2 antibodies and potential determinants among the Belgian adult population: baseline results of a prospective cohort study. Viruses. 2022;14(5):920.  https://doi.org/10.3390/v14050920  PMID: 35632663 
  16. Canto e Castro L, Gomes A, Serrano M, Pereira AH, Ribeiro R, Napoleão P et al. Longitudinal SARS-CoV-2 seroprevalence in Portugal and antibody maintenance 12 months after the start of the COVID-19 pandemic. Research Square. 2021.  https://doi.org/10.21203/rs.3.rs-603060/v1 
  17. Statistics Poland. Statistical data. Population. Size and structure and vital statistics in Poland by territorial divison. As of 30 June 2020 (Table 14). Warsaw: Statistics Poland. [Accessed: 5 Aug 2022]. Available from https://stat.gov.pl/en/topics/population/population/population-size-and-structure-and-vital-statistics-in-poland-by-territorial-divison-as-of-june-30-2020,3,28.html
  18. Dowd JB, Andriano L, Brazel DM, Rotondi V, Block P, Ding X, et al. Demographic science aids in understanding the spread and fatality rates of COVID-19. Proc Natl Acad Sci USA. 2020;117(18):9696-8.  https://doi.org/10.1073/pnas.2004911117  PMID: 32300018 
  19. Statistics Poland. Gospodarstwa domowe i rodziny. Charakterystyka demograficzna - NSP 2011. [Households and families. Demographic characteristics – national census 2011]. Warsaw: Statistics Poland; 2014. Polish. Available from: https://stat.gov.pl/spisy-powszechne/nsp-2011/nsp-2011-wyniki/gospodarstwa-domowe-i-rodziny-charakterystyka-demograficzna-nsp-2011,5,1.html
  20. Ghosh AK, Venkatraman S, Soroka O, Reshetnyak E, Rajan M, An A, et al. Association between overcrowded households, multigenerational households, and COVID-19: a cohort study. Public Health. 2021;198:273-9.  https://doi.org/10.1016/j.puhe.2021.07.039  PMID: 34492508 
  21. Mikolai J, Keenan K, Kulu H. Intersecting household-level health and socio-economic vulnerabilities and the COVID-19 crisis: An analysis from the UK. SSM Popul Health. 2020;12:100628.  https://doi.org/10.1016/j.ssmph.2020.100628  PMID: 32838017 
  22. Scientific Advisory Group for Emergencies (SAGE). Housing, household transmission and ethnicity, 26 November 2020. London: SAGE; 2020. Available from: https://www.gov.uk/government/publications/housing-household-transmission-and-ethnicity-26-november-2020
  23. Statistics Poland. Knowledge Databases. Statistical data. Out-patient health care. Warsaw: Statistics Poland. [Accessed: 15 Aug 2023]. Available from: http://swaid.stat.gov.pl/EN/ZdrowieOchronaZdrowia_dashboards/Raporty_predefiniowane/RAP_DBD_ZDR_1.aspx
  24. Laajaj R, Webb D, Aristizabal D, Behrentz E, Bernal R, Buitrago G, et al. Understanding how socioeconomic inequalities drive inequalities in COVID-19 infections. Sci Rep. 2022;12(1):8269.  https://doi.org/10.1038/s41598-022-11706-7  PMID: 35585211 
  25. Callaghan T, Lueck JA, Trujillo KL, Ferdinand AO. Rural and urban differences in COVID-19 prevention behaviors. J Rural Health. 2021;37(2):287-95.  https://doi.org/10.1111/jrh.12556  PMID: 33619836 
  26. Park M, Lim JT, Wang L, Cook AR, Dickens BL. Urban-rural disparities for COVID-19: evidence from 10 countries and areas in the Western Pacific. Health Data Sci. 2021;2021:9790275.  https://doi.org/10.34133/2021/9790275  PMID: 36405354 
  27. Li Y, Hu T, Gai X, Zhang Y, Zhou X. Transmission dynamics, heterogeneity and controllability of SARS-CoV-2: a rural-urban comparison. Int J Environ Res Public Health. 2021;18(10):5221.  https://doi.org/10.3390/ijerph18105221  PMID: 34068947 
  28. Centre of Monitoring and Analyses of Population Health. National Institute of Public Health – National Institute of Hygiene (NIPH NIH–NRI). Tabele wynikowe Badania Chorobowości Szpitalnej Ogólnej, 2021 r. [Result tables of the General Hospital Morbidity Study, 2021]. Warsaw: (NIPH NIH–NRI). [Accessed: 15 Aug 2023]. Polish. Available from: http://www.statystyka1.medstat.waw.pl/wyniki/TabelaEurostat2021.htm
  29. Doerre A, Doblhammer G. The influence of gender on COVID-19 infections and mortality in Germany: Insights from age- and gender-specific modeling of contact rates, infections, and deaths in the early phase of the pandemic. PLoS One. 2022;17(5):e0268119.  https://doi.org/10.1371/journal.pone.0268119  PMID: 35522614 
  30. Kennedy C, Hartig H. Response rates in telephone surveys have resumed their decline. Washington: Pew Research Center; 2019. Available from: https://www.pewresearch.org/fact-tank/2019/02/27/response-rates-in-telephone-surveys-have-resumed-their-decline

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