Socioeconomic position and the COVID-19 care cascade from testing to mortality in Switzerland: a population-based analysis
Summary: Background: The inverse care law states that disadvantaged populations need more health care than advantaged populations but receive less. Gaps in COVID-19-related health care and infection control are not well understood. We aimed to examine inequalities in health in the care cascade from...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2021-09-01
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| Series: | The Lancet Public Health |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2468266721001602 |
| _version_ | 1818681912776982528 |
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| author | Julien Riou, PhD Radoslaw Panczak, PhD Christian L Althaus, PhD Christoph Junker, MD Damir Perisa, PhD Katrin Schneider, PhD Nicola G Criscuolo, MSc Nicola Low, MD Matthias Egger, ProfMD |
| author_facet | Julien Riou, PhD Radoslaw Panczak, PhD Christian L Althaus, PhD Christoph Junker, MD Damir Perisa, PhD Katrin Schneider, PhD Nicola G Criscuolo, MSc Nicola Low, MD Matthias Egger, ProfMD |
| author_sort | Julien Riou, PhD |
| collection | DOAJ |
| description | Summary: Background: The inverse care law states that disadvantaged populations need more health care than advantaged populations but receive less. Gaps in COVID-19-related health care and infection control are not well understood. We aimed to examine inequalities in health in the care cascade from testing for SARS-CoV-2 to COVID-19-related hospitalisation, intensive care unit (ICU) admission, and death in Switzerland, a wealthy country strongly affected by the pandemic. Methods: We analysed surveillance data reported to the Swiss Federal Office of Public Health from March 1, 2020, to April 16, 2021, and 2018 population data. We geocoded residential addresses of notifications to identify the Swiss neighbourhood index of socioeconomic position (Swiss-SEP). The index describes 1·27 million small neighbourhoods of approximately 50 households each on the basis of rent per m2, education and occupation of household heads, and crowding. We used negative binomial regression models to calculate incidence rate ratios (IRRs) with 95% credible intervals (CrIs) of the association between ten groups of the Swiss-SEP index defined by deciles (1=lowest, 10=highest) and outcomes. Models were adjusted for sex, age, canton, and wave of the epidemic (before or after June 8, 2020). We used three different denominators: the general population, the number of tests, and the number of positive tests. Findings: Analyses were based on 4 129 636 tests, 609 782 positive tests, 26 143 hospitalisations, 2432 ICU admissions, 9383 deaths, and 8 221 406 residents. Comparing the highest with the lowest Swiss-SEP group and using the general population as the denominator, more tests were done among people living in neighbourhoods of highest SEP compared with lowest SEP (adjusted IRR 1·18 [95% CrI 1·02–1·36]). Among tested people, test positivity was lower (0·75 [0·69–0·81]) in neighbourhoods of highest SEP than of lowest SEP. Among people testing positive, the adjusted IRR was 0·68 (0·62–0·74) for hospitalisation, was 0·54 (0·43–0·70) for ICU admission, and 0·86 (0·76–0·99) for death. The associations between neighbourhood SEP and outcomes were stronger in younger age groups and we found heterogeneity between areas. Interpretation: The inverse care law and socioeconomic inequalities were evident in Switzerland during the COVID-19 epidemic. People living in neighbourhoods of low SEP were less likely to be tested but more likely to test positive, be admitted to hospital, or die, compared with those in areas of high SEP. It is essential to continue to monitor testing for SARS-CoV-2, access and uptake of COVID-19 vaccination and outcomes of COVID-19. Governments and health-care systems should address this pandemic of inequality by taking measures to reduce health inequalities in response to the SARS-CoV-2 pandemic. Funding: Swiss Federal Office of Public Health, Swiss National Science Foundation, EU Horizon 2020, Branco Weiss Foundation. |
| first_indexed | 2024-12-17T10:10:29Z |
| format | Article |
| id | doaj.art-7b6395be2069450c8df9ad227e4196f5 |
| institution | Directory Open Access Journal |
| issn | 2468-2667 |
| language | English |
| last_indexed | 2024-12-17T10:10:29Z |
| publishDate | 2021-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Public Health |
| spelling | doaj.art-7b6395be2069450c8df9ad227e4196f52022-12-21T21:53:03ZengElsevierThe Lancet Public Health2468-26672021-09-0169e683e691Socioeconomic position and the COVID-19 care cascade from testing to mortality in Switzerland: a population-based analysisJulien Riou, PhD0Radoslaw Panczak, PhD1Christian L Althaus, PhD2Christoph Junker, MD3Damir Perisa, PhD4Katrin Schneider, PhD5Nicola G Criscuolo, MSc6Nicola Low, MD7Matthias Egger, ProfMD8Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Federal Office of Public Health, Liebefeld, SwitzerlandInstitute of Social and Preventive Medicine, University of Bern, Bern, SwitzerlandInstitute of Social and Preventive Medicine, University of Bern, Bern, SwitzerlandFederal Office of Public Health, Liebefeld, SwitzerlandFederal Office of Public Health, Liebefeld, SwitzerlandFederal Office of Public Health, Liebefeld, SwitzerlandDepartment of Environmental Systems Science, ETH Zürich, Zurich, SwitzerlandInstitute of Social and Preventive Medicine, University of Bern, Bern, SwitzerlandInstitute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa; Correspondence to: Prof Matthias Egger MD, Institute of Social and Preventive Medicine, Bern, SwitzerlandSummary: Background: The inverse care law states that disadvantaged populations need more health care than advantaged populations but receive less. Gaps in COVID-19-related health care and infection control are not well understood. We aimed to examine inequalities in health in the care cascade from testing for SARS-CoV-2 to COVID-19-related hospitalisation, intensive care unit (ICU) admission, and death in Switzerland, a wealthy country strongly affected by the pandemic. Methods: We analysed surveillance data reported to the Swiss Federal Office of Public Health from March 1, 2020, to April 16, 2021, and 2018 population data. We geocoded residential addresses of notifications to identify the Swiss neighbourhood index of socioeconomic position (Swiss-SEP). The index describes 1·27 million small neighbourhoods of approximately 50 households each on the basis of rent per m2, education and occupation of household heads, and crowding. We used negative binomial regression models to calculate incidence rate ratios (IRRs) with 95% credible intervals (CrIs) of the association between ten groups of the Swiss-SEP index defined by deciles (1=lowest, 10=highest) and outcomes. Models were adjusted for sex, age, canton, and wave of the epidemic (before or after June 8, 2020). We used three different denominators: the general population, the number of tests, and the number of positive tests. Findings: Analyses were based on 4 129 636 tests, 609 782 positive tests, 26 143 hospitalisations, 2432 ICU admissions, 9383 deaths, and 8 221 406 residents. Comparing the highest with the lowest Swiss-SEP group and using the general population as the denominator, more tests were done among people living in neighbourhoods of highest SEP compared with lowest SEP (adjusted IRR 1·18 [95% CrI 1·02–1·36]). Among tested people, test positivity was lower (0·75 [0·69–0·81]) in neighbourhoods of highest SEP than of lowest SEP. Among people testing positive, the adjusted IRR was 0·68 (0·62–0·74) for hospitalisation, was 0·54 (0·43–0·70) for ICU admission, and 0·86 (0·76–0·99) for death. The associations between neighbourhood SEP and outcomes were stronger in younger age groups and we found heterogeneity between areas. Interpretation: The inverse care law and socioeconomic inequalities were evident in Switzerland during the COVID-19 epidemic. People living in neighbourhoods of low SEP were less likely to be tested but more likely to test positive, be admitted to hospital, or die, compared with those in areas of high SEP. It is essential to continue to monitor testing for SARS-CoV-2, access and uptake of COVID-19 vaccination and outcomes of COVID-19. Governments and health-care systems should address this pandemic of inequality by taking measures to reduce health inequalities in response to the SARS-CoV-2 pandemic. Funding: Swiss Federal Office of Public Health, Swiss National Science Foundation, EU Horizon 2020, Branco Weiss Foundation.http://www.sciencedirect.com/science/article/pii/S2468266721001602 |
| spellingShingle | Julien Riou, PhD Radoslaw Panczak, PhD Christian L Althaus, PhD Christoph Junker, MD Damir Perisa, PhD Katrin Schneider, PhD Nicola G Criscuolo, MSc Nicola Low, MD Matthias Egger, ProfMD Socioeconomic position and the COVID-19 care cascade from testing to mortality in Switzerland: a population-based analysis The Lancet Public Health |
| title | Socioeconomic position and the COVID-19 care cascade from testing to mortality in Switzerland: a population-based analysis |
| title_full | Socioeconomic position and the COVID-19 care cascade from testing to mortality in Switzerland: a population-based analysis |
| title_fullStr | Socioeconomic position and the COVID-19 care cascade from testing to mortality in Switzerland: a population-based analysis |
| title_full_unstemmed | Socioeconomic position and the COVID-19 care cascade from testing to mortality in Switzerland: a population-based analysis |
| title_short | Socioeconomic position and the COVID-19 care cascade from testing to mortality in Switzerland: a population-based analysis |
| title_sort | socioeconomic position and the covid 19 care cascade from testing to mortality in switzerland a population based analysis |
| url | http://www.sciencedirect.com/science/article/pii/S2468266721001602 |
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