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. 2022 Mar;76(3):261-267.
doi: 10.1136/jech-2021-216778. Epub 2021 Sep 15.

Inequitable impact of infection: social gradients in severe COVID-19 outcomes among all confirmed SARS-CoV-2 cases during the first pandemic wave in Sweden

Per E Gustafsson  1 , Miguel San Sebastian  2 , Osvaldo Fonseca-Rodriguez  3 , Anne-Marie Fors Connolly  3
Affiliations

Inequitable impact of infection: social gradients in severe COVID-19 outcomes among all confirmed SARS-CoV-2 cases during the first pandemic wave in Sweden

Per E Gustafsson et al. J Epidemiol Community Health. 2022 Mar.

Abstract

Background: The backdrop of the ubiquitous social inequalities has increasingly come into foreground in research on the COVID-19 pandemic, but the lack of high-quality population-based studies limits our understanding of the inequitable outcomes of the disease. The present study seeks to estimate social gradients in COVID-19 hospitalisations, intensive care admissions and death by education, income and country of birth, while taking into account disparities in comorbidities.

Methods: We used a register-based retrospective open cohort design enrolling all 74 659 confirmed SARS-CoV-2-positive cases aged >25 years in Sweden during the first wave of the pandemic (until 14 September 2020). Information was retrieved from multiple registers and linked by the unique Swedish personal identity number concerning COVID-19 case identification; COVID-19 hospitalisations, intensive care admissions and death; comorbidities as measured by the Charlson Comorbidity Index; and sociodemographic information. Social gradients were estimated by the Relative Index of Inequality (RII) using Cox regression.

Results: Adjusted analyses showed significant social gradients in COVID-19 hospitalisation, intensive care admission, across education, income and country of birth, which were unaffected by adjustment for comorbidities. Education and country of birth gradients were stronger for hospitalisation and intensive care admissions but small to non-existent for death. In contrast, income gradients were consistent across all three COVID-19 outcomes.

Conclusion: Social gradients in severe COVID-19 outcomes are widespread in Sweden, but appear to be unrelated to pre-existing health disparities. Inequitable outcomes of SARS-CoV-2 infection may therefore be at least partially avoidable and could rely on equitable management of confirmed COVID-19 cases.

Keywords: COVID-19; cohort studies; directory; health inequalities; social epidemiology.

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Conflict of interest statement

Competing interests: None declared.

References

    1. Marmot M, Allen J. COVID-19: exposing and amplifying inequalities. J Epidemiol Community Health 2020;74:681–2. 10.1136/jech-2020-214720 - DOI - PMC - PubMed
    1. Bambra C, Riordan R, Ford J, et al. . The COVID-19 pandemic and health inequalities. J Epidemiol Community Health 2020;74:964–8. 10.1136/jech-2020-214401 - DOI - PMC - PubMed
    1. Khalatbari-Soltani S, Cumming RC, Delpierre C, et al. . Importance of collecting data on socioeconomic determinants from the early stage of the COVID-19 outbreak onwards. J Epidemiol Community Health 2020;74:620–3. 10.1136/jech-2020-214297 - DOI - PMC - PubMed
    1. Dowd JB, Andriano L, Brazel DM, et al. . Demographic science AIDS in understanding the spread and fatality rates of COVID-19. Proc Natl Acad Sci U S A 2020;117:9696–8. 10.1073/pnas.2004911117 - DOI - PMC - PubMed
    1. Ludvigsson JF. The first eight months of Sweden's COVID-19 strategy and the key actions and actors that were involved. Acta Paediatr 2020;109:2459–71. 10.1111/apa.15582 - DOI - PMC - PubMed

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