Spatial Inequality and Infection Risk: Urban Determinants of COVID-19 Exposure

Denis Fernandes Alves and André Luis Squarize Chagas
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Denis Fernandes Alves: Federal University of Pernambuco, Caruaru, Pernambuco, Brazil
André Luis Squarize Chagas: Departmento of Economics, University of S˜ao Paulo, S˜ao Paulo, S˜ao Paulo, Brazil

No 08-2025, TD NEREUS from Núcleo de Economia Regional e Urbana da Universidade de São Paulo (NEREUS)

Abstract: This paper investigates how spatial inequalities in urban infrastructure shape the risk of COVID-19 infection. We develop a stylized urban sorting model with regulated housing markets to formally link residential density, healthcare accessibility, and residence in low-income areas under special planning regulations to heterogeneous contagion risks. The model yields testable propositions, which we evaluate using georeferenced individual-level data from Recife, Brazil. To address endogeneity, we estimate an instrumental variable Probit model, using novel instruments based on 19th-century railway lines, early-2000s building density, and the share of designated low-income areas within each census tract. Results show that greater distance to health services, higher residential density, and residence in low-income neighborhoods each increase infection risk. The effects of distance and density are strongest among individuals aged 20–30, while the low-income area effect is more pronounced among those under 20; combined vulnerabilities amplify risks for older adults. Additional analyses reveal that risk varies systematically across land-use contexts. Our findings demonstrate that urban form and the spatial distribution of public services play a causal role in epidemic exposure, offering lessons for public health strategies in rapidly urbanizing and unequal cities worldwide.

Keywords: Urban sorting; COVID-19 contagion; Spatial Inequality; Healthcare access; Built environment. (search for similar items in EconPapers)
JEL-codes: R10 (search for similar items in EconPapers)
Pages: 26
Date: 2025
New Economics Papers: this item is included in nep-hea and nep-tre
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