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This study aims to investigate the relationship between income inequalities using Gini coefficients and COVID-19 cases and deaths per million population in the EMR countries.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Country-level data on monthly COVID-19 cases and deaths between March 2020 and October 2021, along with data on selected confounders, were collected from publicly available databases. Mixed-effect negative binomial and inverse hyperbolic sine transformation regressions were estimated to examine the association.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The study showed that, in the EMR, a unit increase in Gini coefficient is associated with approximately 7.2% and 3.9% increase in COVID-19 cases and deaths per million population, respectively. The magnitude and direction of the association between income inequality and COVID-19 cases and deaths per-million population still remain the same after excluding four warzone countries from the analysis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>This increase in COVID-19 cases and deaths is underpinned by the fact that a large number of the population in the region is living in conditions of poverty, with inadequate housing, comorbidities and limited or virtually no access to essential healthcare services. Healthcare policy-makers across countries in the region need to implement effective interventions in areas of income inequality, where it may be linked to increasing the risk of COVID-19 cases and deaths.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjgh-2023-012271","type":"journal-article","created":{"date-parts":[[2023,11,2]],"date-time":"2023-11-02T13:36:14Z","timestamp":1698932174000},"page":"e012271","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Income inequality and its association with COVID-19 cases and deaths: a cross-country analysis in the Eastern Mediterranean region"],"prefix":"10.1136","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2590-851X","authenticated-orcid":false,"given":"Mohammed Fasihul","family":"Alam","sequence":"first","affiliation":[{"name":"Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Wildman","sequence":"additional","affiliation":[{"name":"Department of Economics, Newcastle University, Newcastle upon Tyne, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanan","family":"Abdul Rahim","sequence":"additional","affiliation":[{"name":"Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,11,2]]},"reference":[{"key":"2025073014141665000_8.11.e012271.1","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1177\/13505084221090632","article-title":"\u201c'anarchist Technologies': anarchism, cybernetics and mutual aid in community responses to the COVID-19 crisis\u201d","volume":"30","author":"Swann","year":"2023","journal-title":"Organization (Lond)"},{"key":"2025073014141665000_8.11.e012271.2","doi-asserted-by":"crossref","DOI":"10.1177\/2632010X221075584","article-title":"New Coronavirus variants are creating more challenges to global Healthcare system: A brief report on the current knowledge","volume":"15","author":"Islam","year":"2022","journal-title":"Clin Pathol"},{"key":"2025073014141665000_8.11.e012271.3","doi-asserted-by":"crossref","first-page":"e52","DOI":"10.1093\/gerona\/glaa163","article-title":"Unequal impact of structural health determinants and Comorbidity on COVID-19 severity and lethality in older Mexican adults: considerations beyond chronological aging","volume":"76","author":"Bello-Chavolla","year":"2021","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"2025073014141665000_8.11.e012271.4","doi-asserted-by":"publisher","DOI":"10.3961\/jpmph.20.256"},{"key":"2025073014141665000_8.11.e012271.5","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1177\/1090198120929677","article-title":"Social vulnerability and racial inequality in COVID-19 deaths in Chicago","volume":"47","author":"Kim","year":"2020","journal-title":"Health Educ Behav"},{"key":"2025073014141665000_8.11.e012271.6","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1093\/cid\/ciaa815","article-title":"The disproportionate impact of COVID-19 on racial and ethnic minorities in the United States","volume":"72","author":"Tai","year":"2021","journal-title":"Clin Infect Dis"},{"key":"2025073014141665000_8.11.e012271.7","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2020.305913"},{"key":"2025073014141665000_8.11.e012271.8","unstructured":"World Health Organization . 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