Social cohesion and COVID-19 mortality in different periods of the pandemic: variable efficacy of trust in civil services

Aims: Social cohesion has been reported to influence various health outcomes positively. However, inconsistent results were reported regarding the effects of social cohesion dimensions on the COVID-19 mortality rate (MR). Most studies have indicated that trust in civil services but not participating in social activities reduces COVID-19 mortality, possibly because of the highly contagious nature of this disease. In this study, we investigated how the effects of various dimensions of social cohesion on COVID-19 MR vary across different phases of the pandemic. Methods: This study used data from 86 countries participating in the 2017–2020 World Values Survey. The measures of social cohesion were identified by aggregating responses to the country level. COVID-19 MR was calculated—using data from the European Centre for Disease Prevention and Control—separately for three distinct periods during the pandemic: 13 January 2020–8 November 2020; 9 November 2020–5 September 2021; and 6 September 2021–20 June 2022. An exploratory factor analysis (EFA) was conducted to identify the dimensions of social cohesion, and negative binomial regression models were constructed to analyze data for each period. Results: The EFA results revealed three dimensions of social cohesion: social participation and inclusion, health service equality, and trust in civil services and democracy. COVID-19 MR was negatively associated with trust in civil services and democracy during the early two periods and with social participation and inclusion during the late period. Conclusions: Each social cohesion dimension uniquely contributed to reducing the COVID-19 MR in different pandemic periods.