Social determinants of COVID-19 incidence and outcomes: A rapid review

Abstract

Early reports indicate that the social determinants of health are implicated in COVID-19 incidence and outcomes. To inform the ongoing response to the pandemic, we conducted a rapid review of peer-reviewed studies to examine the social determinants of COVID-19. We searched Ovid MEDLINE, Embase, PsycINFO, CINAHL and Cochrane Central Register of Controlled Trials from December 1, 2019 to April 27, 2020. We also searched the bibliographies of included studies, COVID-19 evidence repositories and living evidence maps, and consulted with expert colleagues internationally. We included studies identified through these supplementary sources up to June 25, 2020. We included English-language peer-reviewed quantitative studies that used primary data to describe the social determinants of COVID-19 incidence, clinical presentation, health service use and outcomes in adults with a confirmed or presumptive diagnosis of COVID-19. Two reviewers extracted data and conducted quality assessment, confirmed by a third reviewer. Forty-two studies met inclusion criteria. The strongest evidence was from three large observational studies that found associations between race or ethnicity and socioeconomic deprivation and increased likelihood of COVID-19 incidence and subsequent hospitalization. Limited evidence was available on other key determinants, including occupation, educational attainment, housing status and food security. Assessing associations between sociodemographic factors and COVID-19 was limited by small samples, descriptive study designs, and the timeframe of our search. Systematic reviews of literature published subsequently are required to fully understand the magnitude of any effects and predictive utility of sociodemographic factors related to COVID-19 incidence and outcomes. PROSPERO: CRD4202017813.

Socioeconomic Status and COVID-19 Related Outcomes in India: Hospital Based Study

“…11 In the COVID-19 pandemic, studies from most developed countries have reported greater COVID-19 related mortality and adverse outcomes among the ethnic minorities. 3,4,5 However, association of mortality among low socioeconomic or less educational status individuals are inconclusive. 3,4,12,13,14 In England, OpenSAFELY platform evaluated ethnic differences in COVID-19 related hospitalization, intensive care unit admission and death in 17 million adults from the National Health Service.…”

“…3,4,5 However, association of mortality among low socioeconomic or less educational status individuals are inconclusive. 3,4,12,13,14 In England, OpenSAFELY platform evaluated ethnic differences in COVID-19 related hospitalization, intensive care unit admission and death in 17 million adults from the National Health Service. 23 As compared to British White group, deaths were higher in South Asians in the first wave (OR 1.08, CI 1.07-1.09), and the second wave of COVID-19 epidemic (OR 1.87, CI 1.68-2.07) as well as in the overall cohort (OR 1.26, CI 1.15-1.37).…”

“…2 Epidemiological studies from China, Europe, UK and USA have shown greater disease burden in socioeconomically deprived neighborhoods and minority ethnic groups. 3 A review that included more than 18.7 million patients from 50 studies in UK and USA reported that individuals from Black and Asian ethnicities had 1.5-2.0 time greater risk of COVID-19 infection compared to White individuals and individuals of Asian ethnicity were at greater risk for intensive-care unit admission and death. 4 Multiple reasons have been postulated for these socioeconomic disparities and include factors such as poverty, racism and other structural factors, lower availability, access, affordability and utilization of healthcare and low value care.…”

“…8,11 Association of socioeconomic status with COVID-19 related outcomes has not been well studied. A rapid review identified 42 studies that evaluated social determinants of COVID-19 incidence, clinical presentation, health service use and outcomes, 3 and reported significant associations of race, ethnicity and social deprivation with increased COVID-19 incidence and hospitalization. The review also reported that there was limited evidence regarding other key determinants including occupation, education, housing status and food security and suggested larger epidemiological studies to obtain high-quality evidence.…”

Improving Social Justice in COVID-19 Health Research: Interim Guidelines for Reporting Health Equity in Observational Studies

“…However, data examining the role of the social determinants of health within the context of the COVID-19 pandemic have been less prominent than research focusing on the biomedical paradigm [16,17]. A recent rapid review of COVID-19 studies examining infection, health service use, and health outcomes, found a minority of studies that had assessed outcomes according to social determinants of health [18]. Moreover, social determinants are rarely incorporated into mathematical modelling studies, which have achieved substantive importance in informing policy-makers about the impact of disease and interventions in the population over time [19,20].…”