COVID-19 related health inequality exists even in a city where disease incidence is relatively low: a telephone survey in Hong Kong

Abstract

BackgroundWe examined whether COVID-19 could exert inequalities in socioeconomic conditions and health in Hong Kong, where there has been a relatively low COVID-19 incidence.Methods752 adult respondents from a previous random sample participated in a telephone survey from 20 April to 11 May 2020. We examined demographic and socioeconomic factors, worry of COVID-19, general health, economic activity, and personal protective equipment (PPE) and related hygiene practice by deprivation status. The associations between deprivation and negative COVID-19 related issues were analysed using binary logistic regressions, while the associations of these issues with health were analysed using linear regressions. Path analysis was conducted to determine the direct effect of deprivation, and the indirect effects via COVID-19 related issues, on health. Interactions between deprivation and the mediators were also tested.ResultsDeprived individuals were more likely to have job loss/instability, less reserves, less utilisation and more concerns of PPE. After adjustments for potential confounders, being deprived was associated with having greater risk of low reserve of face masks, being worried about the disease and job loss/instability. Being deprived had worse physical (β=−0.154, p<0.001) and mental health (β=−0.211, p<0.001) and had an indirect effect on mental health via worry and job loss/instability (total indirect effect: β=−0.027, p=0.017; proportion being mediated=11.46%). In addition, significant interaction between deprivation and change of economic activity status was observed on mental health-related quality of life.ConclusionEven if the COVID-19 incidence was relatively low, part of the observed health inequality can be explained by people’s concerns over livelihood and economic activity, which were affected by the containment measures. We should look beyond the incidence to address COVID-19 related health inequalities.

Psychological Distress and Protective Behaviors During the COVID-19 Pandemic Among Different Populations: Hong Kong General Population, Taiwan Healthcare Workers, and Taiwan Outpatients

“…Taken together, those who were worried about personal savings, who also tended to be of a lower socioeconomic position in Hong Kong, may have experienced a greater level of psychosocial distress under the pandemic-related economic downturn. This is also in line with the previous COVID-19 research in Hong Kong supporting a partial mediation of inequalities in mental health via people's concerns over livelihood and economic activity (68,69). Furthermore, studies in Hong Kong also revealed that the socially deprived individuals tended to be more concerned about PPE as they had lower reserves and hence utilization (68,70), which may help explain why to worry about personal savings acted as a risk factor of personal hygiene practices but a facilitator of reduced social gatherings in Hong Kong.…”

“…This is also in line with the previous COVID-19 research in Hong Kong supporting a partial mediation of inequalities in mental health via people's concerns over livelihood and economic activity (68,69). Furthermore, studies in Hong Kong also revealed that the socially deprived individuals tended to be more concerned about PPE as they had lower reserves and hence utilization (68,70), which may help explain why to worry about personal savings acted as a risk factor of personal hygiene practices but a facilitator of reduced social gatherings in Hong Kong. Adopting personal hygiene practices may be costly and so they engaged in these behaviors less frequently; instead, reducing social gatherings can help them save money and PPE.…”

COVID-19 Worry and Mental Health Among the Economically Active Population in Guangdong, China

“…An online study on Russian-speaking healthcare workers also found that the increase in anxiety concerns about COVID-19 was associated with an increase in psychological distress ( 8 ). Moreover, it has been determined that even in regions with low rates of SARS-CoV-2 infection, COVID-19 worry significantly contributes to a general population's worsened mental health ( 9 – 11 ). As an illustration, a recent study in Hong Kong showed that compared to individuals who were less worried about COVID-19, those who were more worried about COVID-19 were more likely to have mental health problems ( 10 ).…”

“…Furthermore, previous studies have reported that the effect of COVID-19 worry on mental health might vary between social groups with different demographic characteristics and economic statuses. In particular, sex, age, and socioeconomic status have been determined to be key factors mediating the impact of COVID-19 worry on mental health ( 2 , 9 , 12 , 13 ). First, some studies have shown that women are more likely than men to suffer mental health problems due to COVID-19 worry ( 2 , 14 ).…”

Differential Impacts of Multimorbidity on COVID-19 Severity across the Socioeconomic Ladder in Hong Kong: A Syndemic Perspective

“…Hong Kong could serve as an exemplary setting for an in-depth investigation of the socioeconomic inequalities in COVID-19 severity. Compared with many other regions with widespread community COVID-19 outbreaks, Hong Kong has a relatively low COVID-19 incidence with less than 9000 confirmed cases and 150 deaths by the end of 2020 [14,15]. In addition to the better-controlled COVID-19 outbreak, the public-private dual-track healthcare system in Hong Kong also has a strong equity impact on both COVID-19 treatment and socioeconomic inequalities in chronic disease management.…”