Social and Policy Determinants of COVID-19 Infection Across 23 Countries: An Ecological Study

Abstract

Objectives: This study aimed to identify the social and policy determinants of coronavirus disease 2019 (COVID-19) infection across 23 countries.Methods: COVID-19 indicators (incidence, mortality, and fatality) for each country were calculated by direct and indirect standardization. Multivariable regression analyses were used to identify the social and policy determinants of COVID-19 infection.Results: A higher number of doctors per population was related to lower incidence, mortality, and fatality rates of COVID-19 in 23 countries (β=-0.672, -0.445, and -0.564, respectively). The number of nurses/midwives per population was associated with lower mortality and fatality rates of COVID-19 in 23 countries (β=-0.215 and -0.372, respectively). Strengthening of policy restriction indicators, such as restrictions of public gatherings, was related to lower COVID-19 incidence (β=-0.423). A national Bacillus Calmette–Guérin vaccination policy conducted among special groups or in the past was associated with a higher incidence of COVID-19 in 23 countries (β=0.341). The proportion of the elderly population (aged over 70 years) was related to higher mortality and fatality rates (β=0.209 and 0.350, respectively), and income support was associated with mortality and fatality rates (β=-0.362 and -0.449, respectively).Conclusions: These findings do not imply causality because this was a country-based correlation study. However, COVID-19 transmission can be influenced by social and policy determinants such as integrated health systems and policy responses to COVID-19. Various social and policy determinants should be considered when planning responses to COVID-19.

Country-level and regional COVID-19 burden and determinants across OECD member states and partner countries

“…Furthermore, our study showed an inverse relationship between the ratio nurse per 10,000 and COVID-19 fatalities, suggesting that OECD states and partner countries with low ratio tended to have more COVID-19 fatalities. Another recent ecological study that searched to determine the predictors of SARS-CoV-2 infection also showed that the ratio nurses/midwives per population was inversely associated with COVID-19 mortality [ 31 ]. Nurses are among frontliners to safeguard the lives of affected persons during health crises.…”

The association between tobacco or nicotine product use behaviors and non-compliance with mask-wearing during the COVID-19 pandemic: a cross-sectional study in Korea

“…Smokers are more associated with COVID-19 morbidity than non-smokers [ 32 , 33 ]. Even though there was a study [ 22 ] reports that a significant difference in the morbidity of COVID-19 between smokers and non-smokers was absent, the results of our study cannot be excluded.…”

Social and Policy Determinants of COVID-19

“…We would like to share some ideas related to the recently published article, “Social and Policy Determinants of COVID-19 Infection Across 23 Countries: An Ecological Study” [ 1 ]. Coronavirus disease 2019 (COVID-19) transmission can be influenced by social and policy determinants, such as integrated health systems and policy responses to COVID-19, according to Kim et al [ 1 ]. When responding to COVID-19, a variety of socioeconomic and policy issues should be taken into account [ 1 ].…”

“…Coronavirus disease 2019 (COVID-19) transmission can be influenced by social and policy determinants, such as integrated health systems and policy responses to COVID-19, according to Kim et al [ 1 ]. When responding to COVID-19, a variety of socioeconomic and policy issues should be taken into account [ 1 ]. We agree that any disease can be impacted by local socioeconomic and policy factors.…”