The unequal burden of COVID-19 across Canadian provinces: Social determinants and public health responses

Objectives The COVID-19 pandemic exposed substantial social and regional inequalities across Canada. This study aims to examine variations in COVID-19 incidence across Canadian provinces between February 2020 and December 2022. The analysis investigates how social determinants, public health policy responses, and provincial political contexts were associated with confirmed COVID-19 cases across different levels of pandemic severity. Study design This study employs a longitudinal ecological panel design. Methods The study uses weekly panel data from all ten Canadian provinces and integrates epidemiological health outputs, social determinants, public health policy measures, and political governance characteristics. Methodologically, the study applies the Method of Moments Quantile Regression (MMQR) approach to examine heterogeneous relationships across different quantiles of confirmed COVID-19 cases. Results The findings reveal that the associations between the explanatory variables and COVID-19 cases varied across pandemic severity levels. Lower income, lower employment, lower education, limited healthcare access, and housing affordability pressures were generally associated with higher infection levels, particularly during severe outbreak periods. Government policy interventions also demonstrated heterogeneous associations across different levels of pandemic intensity. In addition, provincial political contexts were associated with variations in infection patterns across the distribution of confirmed cases. Conclusion The findings highlight that effective pandemic preparedness depends not only on social determinants and public health measures, but also on broader structural, institutional, and governance contexts that shape policy priorities, resource allocation, and population health responses during future public health crises.