Socioeconomic determinants of protective behaviors and contact patterns in the post-COVID-19 pandemic era: a cross-sectional study in Italy

Abstract: Socioeconomic inequalities significantly influence infectious disease outcomes, as seen with COVID-19, but the pathways through which socioeconomic conditions affect transmission dynamics remain unclear. To address this, we conducted a survey representative of the Italian population, stratified by age, gender, geographical area, city size, employment status, and education level. The survey's final aim was to estimate differences in contact and protective behaviors across various population strata, both being key components of transmission dynamics. Our initial insights based on the survey indicate that years after the pandemic began, the perceived impact of COVID-19 on professional, economic, social, and psychological dimensions varied across socioeconomic strata, extending beyond the heterogeneity observed in the epidemiological outcomes of the pandemic. This reinforces the need for approaches that systematically consider socioeconomic determinants. In this context, using generalized models, we identified associations between socioeconomic factors and vaccination status for both COVID-19 and influenza, as well as the influence of socioeconomic conditions on mask-wearing and social distancing. Importantly, we also observed differences in contact behaviors based on employment status while education level did not show a significant association. These findings highlight the complex interplay of socioeconomic and demographic factors in shaping individual responses to public health measures. Understanding these dynamics is essential for developing effective epidemic models and targeted public health strategies, particularly for vulnerable populations.