Geographical distribution of the COVID-19 pandemic and key determinants: Evolution across waves in Spain

Amidst the COVID-19 pandemic, most research has examined specific temporal snapshots. This study diverges by offering a comprehensive analysis of COVID-19 incidence across the Spanish provinces throughout six distinct waves of the pandemic. Using spatial exploratory techniques, we find no single pandemic; rather, there have been waves. Significant differences in the spatial distribution of cases and deaths across six waves show that each has unique characteristics. Homogeneous conclusions cannot be drawn at the national level. Notable regional differences in the pandemic’s spatial distribution suggest a need for subnational responses, reflecting variations in climate, economic dynamism, sectoral specialisation, and socio-health resources. Spatial regression models show that the main determinants of COVID-19 incidence depend on stage. Traditional factors commonly associated with epidemiological studies, such as temperature, exerted significant influence during the pandemic’s onset. However, as mobility restrictions were enforced and vaccination campaigns were rolled out, economic conditions, and especially levels of economic activity, emerged as increasingly significant determinants.