Regional-level social determinants of health associated with COVID-19 mortality, study finds

November 09, 2022

2 minute read


Disclosures: Wang does not report any relevant financial information. Please see the study for relevant financial information from all other authors.


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According to a recent study conducted in Clinical infectious diseases.

“Social determinants of health (SDOH) such as income, education, and race/ethnicity play an important role in COVID-19 outcomes. These factors can impact COVID-19-related death through a combination of the following pathways: likelihood of infection, likelihood of diagnosis once infected, and likelihood of COVID-19-related death once diagnosed,” Linwei Wang, MSc, epidemiologist at St. Michael Hospital MAP Center for Urban Health Solutions, Healio told. “Understanding the mechanisms by which SDOH influences COVID-19-related deaths can help inform pandemic responses to address prevention gaps associated with SDOH.”



IDN1122Wang_Graphic_01_WEB
Wang L, et al. Clin Infect Dis. 2022;doi:10.1093/cid/ciac850.

Using data from 11.8 million adults living in Ontario, Canada, between March 1, 2020 and March 2, 2021, Wang and colleagues assessed trends in COVID-19-related mortality by a set of area-level SDOH factors which included socio-economic status, ethnic diversity and housing conditions.

According to the study, the researchers used this data to determine if SDOH patterns can be explained by individuals’ demographic and clinical factors. They then compared these area-level SDOH patterns in COVID-19-related mortality versus those in non-COVID-19-related mortality to understand whether the same patterns of inequality lead to both to COVID-19 and not related to COVID-19.

Of 11,810,255 people assessed, researchers found 3,880 (0.03%) COVID-19 related deaths and 88,107 (0.75%) non-COVID-19 related deaths.

Overall, they found that areas characterized by lower socioeconomic status – including lower median household income (HR=1.3; 95% CI, 1.04-1.62), lower proportion of graduates or higher education (HR=1.27; 95% CI, 1.07-1.52) and higher proportion of essential workers (HR=1.28; 95% CI , 1.05-1.57) – higher proportion of racially minority groups (HR = 1.42; 95% CI, 1.08-1.87), more apartment buildings (HR = 1, 25; 95% CI 1.07-1.46) and large or medium-sized households (HR=1.3; 95% CI, 1.12-1.5) experienced mortality related to COVID-19 higher, even after accounting for individual patient demographics, clinical factors, and other areas. SDOH level.

Wang said these data confirm that the majority of social and structural inequities in COVID-19 mortality “stem from proximal exposures and from the reach and access to prevention interventions.”

Wang added, however, that the negative relationship between income and COVID-19-related death after diagnosis may also reflect delayed diagnosis or access and quality of clinical care for people living in low-income areas. .

“Going forward, the focus of pandemic responses should include improving the overall health of the population by addressing the disproportionate risks of acquisition and transmission and inequitable coverage of prevention interventions associated with SDOH,” Wang said. “Tailored strategies include, but are not limited to, paid sick leave and improved workplace health and safety protocols and outbreak management; and community-led, community-tailored outreach for testing, effective isolation, quarantine, and vaccination programs.

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