Background Social determinants of health heavily impact population outcomes. The association between the impact of covid-19 pandemic and health inequalities have been identified in several countries. Comorbidities such as diabetes, cardiovascular diseases and obesity are more prevalent among people from deprived areas. This study aimed to evaluate the association between socio-economic status, based on a Deprivation Index, and the covid-19 related mortality in a Region of Southern Italy in the pre-vaccination pandemic era. Methods A retrospective observational study was conducted considering all SARS-CoV-2 positive patients from Abruzzo Region, Southern Italy, from February 24th, 2020 to January 15th, 2021. Data such as demographic information, comorbidities, hospitalizations and mortality, was obtained during contact-tracing procedures. The Italian socioeconomic deprivation index (DI), divided in quintiles (from 1st less deprived to the 5th most deprived) was attributed to all patient, based on the municipality of residence. A multivariable logistic regression models was performed to evaluate the association between death, as a dependent variable, and DI, dividing the study population in two samples, hospitalized patients and no-hospitalized patients. Results In the study period, 67,489 SARS-Cov-2 positive were considered, of which 2,746 (4.06%) were hospitalized. The prevalence of deaths among those who have been hospitalized is 4.66%, for all others 0.18%. Among hospitalized patients, no association between death and DI was shown. Among patients died outside the hospital, there is a positive association with the fourth (aOR 2.58;95%CI 1.34-4.94) and fifth quintile (aOR 2.39;95%CI 1.21-4.17) of the DI. Conclusions The socioeconomic deprivation is associated with mortality in non-hospitalized SARS-CoV-2 patients and not among hospitalized patients. The care of patient out of the hospital represents an important challenge and these evidences can be of help the policy maker in order to promote preventive measures to address inequalities.