GIS-based spatio-temporal analysis and modeling of COVID-19 incidence rates in Europe.

The COVID-19 epidemic has emerged as one of the most severe public health crises worldwide, especially in Europe. Until early July 2021, reported infected cases exceeded 180 million, with almost 4 million associated deaths worldwide, almost a third of which are in continental Europe. We analyzed the spatio-temporal distribution of the disease incidence and mortality rates considering specific periods in this continent. Further, we applied Global Moran's I to examine the spatio-temporal distribution patterns of COVID-19 incidence rates and Getis-Ord Gi* hotspot analysis to represent high-risk areas of the disease. Additionally, we compiled a set of 40 demographic, socioeconomic, environmental, transportation, health, and behavioral indicators as potential explanatory variables to investigate the spatial variations of COVID-19 cumulative incidence rates (CIRs). Ordinary Least Squares (OLS), Spatial Lag model (SLM), Spatial Error Model (SLM), Geographically Weighted Regression (GWR), and Multiscale Geographically Weighted Regression (MGWR) regression models were implemented to examine the spatial dependence and non-stationary relationships. Based on our findings, the spatio-temporal distribution pattern of COVID-19 CIRs was highly clustered and the most high-risk clusters of the disease were situated in central and western Europe. Moreover, poverty and the elderly population were selected as the most influential variables due to their significant relationship with COVID-19 CIRs. Considering the non-stationary relationship between variables, MGWR could describe almost 69% of COVID-19 CIRs variations in Europe. Since this spatio-temporal research is conducted on a continental scale, spatial information obtained from the models could provide general insights to authorities for further targeted policies.