Social Determinants of Health and Risk of SARS-CoV-2 Infection in Community-Dwelling Older Adults Living in a Rural Latin American Setting

High social risk, as measured by the social determinants of health (SDH), may increase the risk of SARS-CoV-2 infection However, this association has not been studied in rural communities Using the Atahualpa Project cohort, we aimed to assess the association between SDH and SARS-CoV-2 seropositivity in community-dwelling older adults living in rural Ecuador SARS-CoV-2 antibodies were determined in 319 individuals aged ? 60 years that completed a validated field instrument to assess their social risk before the introduction of this novel pandemic Multivariate models were fitted to assess the independent association between SDH-and each of their components-and SARS-CoV-2 seropositivity, after adjusting for relevant covariates According to the Gijon scale, 102 (32%) individuals had a high social risk (? 10 points) A total of 141 (44%) individuals were seropositive to SARS-CoV-2 A fully-adjusted logistic regression model showed an independent) association between social risk and SARS-CoV-2 positivity (OR 1 15;95% CI 1 04-1 27;p = 0 008) For every unit of the total SDH score, the odds of SARS-CoV-2 seropositivity increased 15% (95% CI 3 7-27%) In addition, multivari-ate models showed that the individual component of SDH more strongly associated with SARS-CoV-2 seropositivity was housing, which suggested that lack of basic home facilities may increase the risk of SARS-CoV-2 infection Knowledge on the association between high social risk and SARS-CoV-2 infection is indispensable for the development of cost-effective preventive strategies for controlling modifiable factors that are in the path of SARS-CoV-2 infection among older adults living in underserved communities