Health inequalities in infectious diseases: a systematic overview of reviews

Abstract

Objectives: The aim of this systematic overview of reviews was to synthesise available evidence on inequalities in infectious disease based on three dimensions of inequalities; inclusion health groups, protected characteristics and socioeconomic inequalities.

Methods: We searched MEDLINE, Embase, Web of Science and OpenGrey databases in November 2021. We included reviews published from the year 2000 which examined inequalities in the incidence, prevalence or consequences of infectious diseases based on the dimensions of interest. Our search focused on tuberculosis, HIV, sexually transmitted infections, hepatitis C, vaccination and antimicrobial resistance. However, we also included eligible reviews of any other infectious diseases. We appraised the quality of reviews using the Assessment of Multiple Systematic Reviews V.2 (AMSTAR2) checklist. We conducted a narrative data synthesis.

Results: We included 108 reviews in our synthesis covering all the dimensions of inequalities for most of the infectious disease topics of interest, however the quality and volume of review evidence and consistency of their findings varied. The existing literature reviews provide strong evidence that people in inclusion health groups and lower socioeconomic status are consistently at higher risk of infectious diseases, antimicrobial resistance and incomplete/delayed vaccination. In the protected characteristics dimension, ethnicity, and sexual orientation are important factors contributing to inequalities across the various infectious disease topics included in this overview of reviews.

Conclusion: We identified many reviews that provide evidence of various types of health inequalities in different infectious diseases, vaccination, and antimicrobial resistance. We also highlight areas where reviews may be lacking. The commonalities in the associations and their directions suggest it might be worth targeting interventions for some high risk-groups that may have benefits across multiple infectious disease outcomes rather than operating purely in infectious disease siloes.

Keywords: Epidemiology; INFECTIOUS DISEASES; Public health.

Figure 1

Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram for study selection.

Figure 2

Matrix showing the number of reviews identified for each dimension of inequality and infectious disease topic. Colour ranges from red which indicates where no review was identified, up to green for a maximum number of reviews (19). AMR, antimicrobial resistance; STIs, sexually transmitted infections.

Figure 3

Assessment of Multiple Systematic Reviews V.2 results for included reviews. PICO, population, intervention, comparator group and outcome.