The COVID-19 pandemic has affected cities particularly hard. Here, we provide an in-depth characterization of disease incidence and mortality and their dependence on demographic and socioeconomic strata in Santiago, a highly segregated city and the capital of Chile. Our analyses show a strong association between socioeconomic status and both COVID-19 outcomes and public health capacity. People living in municipalities with low socioeconomic status did not reduce their mobility during lockdowns as much as those in more affluent municipalities. Testing volumes may have been insufficient early in the pandemic in those places, and both test positivity rates and testing delays were much higher. We find a strong association between socioeconomic status and mortality, measured by either COVID-19–attributed deaths or excess deaths. Finally, we show that infection fatality rates in young people are higher in low-income municipalities. Together, these results highlight the critical consequences of socioeconomic inequalities on health outcomes.

COVID-19 大流行对城市的影响尤其严重。在这里，我们深入描述了圣地亚哥这个高度隔离的城市和智利首都的疾病发病率和死亡率及其对人口和社会经济阶层的依赖。我们的分析显示，社会经济地位与 COVID-19 的结果和公共卫生能力之间存在密切关联。生活在社会经济地位较低的城市的人们在封锁期间并没有像生活在较富裕城市的人们那样减少流动性。这些地方在大流行初期的检测量可能不足，而且检测阳性率和检测延迟都高得多。我们发现社会经济地位与死亡率之间存在很强的关联，死亡率可以通过 COVID-19 造成的死亡或超额死亡来衡量。最后，我们发现低收入城市年轻人的感染死亡率更高。总之，这些结果凸显了社会经济不平等对健康结果的严重影响。