Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 50 7 2021 07 01 1324 1333 Liren Yang 1. Department of Obstetrics and Gynecology, Maternal & Child Health Center, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, P.R. China 2. School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, P.R. China Cuifang Qi Department of Obstetrics and Gynecology, Maternal & Child Health Center, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, P.R. China Zixuan Yang Antai College of Economics and Management, Shanghai Jiao Tong University, Shanghai, 200030, P.R. China Li Shang 1. Department of Obstetrics and Gynecology, Maternal & Child Health Center, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, P.R. China 2. School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, P.R. China Guilan Xie 1. Department of Obstetrics and Gynecology, Maternal & Child Health Center, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, P.R. China 2. School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, P.R. China Ruiqi Wang 1. Department of Obstetrics and Gynecology, Maternal & Child Health Center, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, P.R. China 2. School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, P.R. China Landi Sun 1. Department of Obstetrics and Gynecology, Maternal & Child Health Center, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, P.R. China 2. Peking University Health Science Center, Beijing 100191, P.R. China Mengmeng Xu 1. Department of Obstetrics and Gynecology, Maternal & Child Health Center, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, P.R. China 2. Henan University, Kaifeng, Henan 475001, P.R. China Wenfang Yang Department of Obstetrics and Gynecology, Maternal & Child Health Center, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, P.R. China Mei Chun Chung Department of Public Health and Community Medicine, Tufts University School of Medicine, Massachusetts Boston, United States of America 2021 02 27 2021 03 06 Background: This study investigated the impact of socio-economic factors on the spread and outbreak of COVID-19 based on Chinese data. Methods: Cumulative confirmed cases were collected and divided into the First-stage cases cluster dominated by imported cases, and the Second-stage cases cluster dominated by secondary cases, according to the time of emergency state and Wuhan city lockdown. The linear regression was used for data analysis. Results: A total of 12,877 cases in 30 provinces were analyzed in the study. The First-stage cases cluster included 675 cases and Second-stage cases cluster included 12,202 cases. The socio-economic factors were significantly associated with the cases (P<0.05). The GDP and proportion of population moving out of Wuhan were associate with the First-stage dominated by imported cases (b>0, P<0.05). The First-stage cases cluster, proportion of population moving out of Wuhan and urban population were associate with the Second-stage dominated by secondary cases (b>0, P<0.05). Conclusion: Socio-economic factors had impacts on the spread and outbreak of COVID-19. The combination of different socio-economic indicators at different stages of the epidemic may help control the epidemic. https://ijph.tums.ac.ir/index.php/ijph/article/view/24014 https://ijph.tums.ac.ir/index.php/ijph/article/download/24014/7276