Temporal dynamics of socioeconomic inequalities in COVID-19 – a scoping review

Abstract

Background International evidence shows a socially unequal burden of SARS-CoV-2 infections and COVID-19 outcomes across different socioeconomic groups. However, less is known about the temporal dynamics of socioeconomic inequalities in COVID-19 throughout the pandemic. We conducted a scoping review to systematically map and synthesize the available evidence. Methods We conducted a systematic literature search in Embase and Scopus with pre-defined eligibility criteria, including empirical research from 1 January 2020 to 24 August 2021. Additionally, several journals and the reference lists of all included articles were hand-searched to identify relevant studies. We used a standardized charting approach to extract relevant content and narratively synthesized the included evidence. The study follows the PRISMA guidelines for scoping reviews. Results From 8,011 identified records, we finally included 46 articles in the analysis. 50.0% of all included studies were conducted in the United States. The majority of all studies analyzed surveillance data (n = 44) and used area-based socioeconomic indicators on an ecological level (92.5%). The study results show temporal dynamics in COVID-19 inequalities, frequently initiated through higher outcome rates in more affluent populations and subsequent crossover dynamics to higher rates in more deprived populations (41.9%). Furthermore, 91.4% of the analyses show maintaining or worsening social inequalities in health with ongoing pandemic progression, which hit the most deprived populations the hardest. Conclusions The results show worsening social inequalities in COVID-19 over the course of the pandemic, with the most disadvantaged populations most affected during its progression. Targeted prevention and interventions, such as low-threshold testing and vaccination programs, infection protection for precarious jobs or living conditions, and targeted information are crucial to face socioeconomic inequalities throughout pandemics. Key messages