Mapping the burden of COVID-19 infections and estimating the contribution of socioeconomic factors: a cross-sectional study

Introduction: Ecuador was among the countries most severely affected by COVID-19, a consequence of its distinct geographical and socioeconomic vulnerabilities. This study seeks to assess the pandemic’s burden in Ecuador during 2020 by quantifying Disability-Adjusted Life Years (DALYs). Furthermore, it investigates the spatial relationship between Years of Life Lost (YLL) and cantonal-level sociodemographic factors, aiming to identify regional disparities and underlying social determinants that contributed to the observed inequities in health outcomes. Methods: This study conducts a subnational analysis of Ecuador’s COVID-19 burden, examining epidemiological data from February to December 2020 across all 24 provinces and 221 cantons. We utilized morbidity and mortality statistics from the Ministry of Public Health (MoH) alongside national census data to assess disease impact through spatial and demographic disparities. Laboratory-confirmed cases were categorized as deaths or recoveries. DALYs were calculated by gender and age group using the DALY package in R. Spatial autocorrelation analyses were conducted to find associations with locational factors. Results: A total of 125,383 DALYs were recorded for COVID-19 during the study period. Males experienced higher DALYs (Median = 56,859) than females (Median = 28,344; Mann–Whitney U = 24,427,451, p < 0.0001, Hedges’ g = 0.52). The disease burden was particularly high in individuals aged 60 and older. YLL had a geographic pattern, with higher rates in northern and western Ecuador (global Moran’s I = 3.22, p = 0.0006), and was associated with factors such as literacy, ethnicity, and sanitation. Conclusions: COVID-19 imposed a substantial burden of disease in Ecuador in 2020, with nearly all DALYs attributable to premature mortality. Geographic and sociodemographic disparities revealed clusters of excess YLL in cantons with limited healthcare access and structural vulnerabilities. These findings underscore the need for equity-oriented policies and geographically targeted interventions to strengthen health system resilience and reduce future pandemic impacts.