Which Curve Are We Flattening? The Disproportionate Impact of COVID-19 Among Economically Marginalized Communities in Ontario, Canada, Was Unchanged From Wild-Type to Omicron

Ma, Huamei; Chan, Adrienne K.; Baral, Stefan; Fahim, Christine; Straus, Sharon E.; Sander, Beate; Mishra, Sharmistha

doi:10.1093/ofid/ofac690

Cited by 3 publications

(4 citation statements)

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“…Cumulative covid-19 related deaths per capita by neighbourhood income in Ontario, Canada (population 14 million) across seven waves of the pandemic. Neighbourhood level income accounts for household size and is adjusted for city level cost of living9…”

Section: Lessons From the Pandemicmentioning

confidence: 99%

“…8 In Canada's most populous province, Ontario, the income gap in covid-19 outcomes has not improved over time (fig 1). 9 Rates of covid-19 hospital admissions and deaths remained threefold higher in the lowest income neighbourhoods compared with highest income areas in each pandemic wave, despite the province eventually achieving "equality" in two dose vaccine coverage and usual measures of hybrid protection (known infection and vaccination) across income. 9 We examine the ways in which research may have contributed to homogenising public health responses to a heterogeneous epidemic and how research could have been used to shape more tailored health policies and implementation efforts.…”

Section: Lessons From the Pandemicmentioning

confidence: 99%

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Use and misuse of research: Canada’s response to covid-19 and its health inequalities

Mishra

Walker

Wilhelm

et al. 2023

BMJ

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Section: Lessons From the Pandemicmentioning

confidence: 99%

Section: Lessons From the Pandemicmentioning

confidence: 99%

Use and misuse of research: Canada’s response to covid-19 and its health inequalities

Mishra

Walker

Wilhelm

et al. 2023

BMJ

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“…Social inequalities in COVID-19 deaths were evident during the early pandemic period across the world(2–8). Data are emerging to suggest social inequalities in COVID-19 deaths might have persisted into later pandemic waves in the UK(9), the US(10) and Canada(11). However, these studies were limited by their ecological design(10,11) and/or inability to account for potential confounders including comorbidities(9,11).…”

Section: Introductionmentioning

confidence: 99%

Social inequalities in COVID-19 deaths by area-level income: patterns over time and the mediating role of vaccination in a population of 11.2 million people in Ontario, Canada

Wang,

Swayze,

Bodner

et al. 2024

Preprint

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Importance: Social inequalities in COVID-19 deaths were evident early in the pandemic. Less is known about how vaccination may have influenced inequalities in COVID-19 deaths. Objectives: To examine patterns in COVID-19 deaths by area-level income over time and to examine the impact of vaccination on inequality patterns in COVID-19 deaths. Design, setting, and participants: Population-based retrospective cohort study including community-living individuals aged ≥18 years residing in Ontario, Canada, as of March 1, 2020 who were followed through to January 30, 2022 (five pandemic waves). Exposure: Area-level income derived from the 2016 Census at the level of dissemination area categorized into quintiles. Vaccination defined as receiving ≥ 1 dose of Johnson-Johnson vaccine or ≥ 2 doses of other vaccines. Main outcome measures: COVID-19 death defined as death within 30 days following, or 7 days prior to a positive SARS-CoV-2 PCR test. Cause-specific hazard models were used to examine the relationship between income and COVID-19 deaths in each wave. We used regression-based causal mediation analyses to examine the impact of vaccination in the relationship between income and COVID-19 deaths during waves four and five. Results: Of 11,248,572 adults, 7044 (0.063%) experienced a COVID-19 death. After accounting for demographics, baseline health, and area-level social determinants of health, inequalities in COVID-19 deaths by income persisted over time (adjusted hazard ratios (aHR) [95% confidence intervals] comparing lowest-income vs. highest-income quintiles were 1.37[0.98-1.92] for wave one, 1.21[0.99-1.48] for wave two, 1.55[1.22-1.96] for wave three, and 1.57[1.15-2.15] for waves four and five). Of 11,122,816 adults alive by the start of wave four, 7,534,259(67.7%) were vaccinated, with lower odds of vaccination in the lowest-income compared to highest-income quintiles (0.71[0.70-0.71]). This inequality in vaccination accounted for 57.9%[21.9%-94.0%] of inequalities in COVID-19 deaths between individuals in the lowest-income vs. highest-income quintiles. Conclusions: Inequalities by income persisted in COVID-19 deaths over time. Efforts are needed to address both vaccination gaps and residual heightened risks associated with lower income to improve health equity in COVID-19 outcomes.

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“…In Canada, there is limited research on the role of social and demographic factors that may influence both the incidence and within province spread of Mpox (2, 9). This is an important area of study considering prior work conducted in Ontario in the context of similar diseases like Covid-19, where researchers found that people that are marginalized had increased risk of COVID-19 morbidity and mortality as compared to the general population in Ontario (12–14). This may demonstrate possible lack of health service equity (15).…”

Section: Introductionmentioning

confidence: 99%

Geographical distribution and the impact of socio-environmental indicators on incidence of Mpox in Ontario, Canada

Ugwu,

Asgary,

et al. 2024

Preprint

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Background: Ontario, being one of Canada's largest provinces, has been central to the high incidence of human Mpox. Research is scarce on how socio-environmental factors influence Mpox incidences. This study seeks to explore potential geographical correlations and the relationship between indicators of social marginalization and Mpox incidence rate in Ontario. Methodology: We used surveillance data on confirmed human Mpox cases from May 1, 2022, to March 31, 2024, extracted from the Public Health Ontario website for this study. Spatial autocorrelation of Mpox incidence was investigated using spatial methods including Moran’s Index, Getis–Ord Gi*statistic, and spatial scan statistic. Following this, we adopted a generalized Poisson regression (GPR) model to estimate the incidence rate ratios (IRRs) based on the association between Ontario PHU-level marginalization and Mpox incidence, while adjusting for age and sex. The goodness-of-fit of the models was assessed using the Akaike Information Criterion (AIC), Akaike’s Information Criterion corrected (AICc), and the Bayesian Information Criterion (BIC). Results: Spatial scan statistics, LISA, and Getis-Ord Gi*statistics revealed similar results for PHUs with the highest rates of Mpox in Ontario. Our study detected statistically significantly higher Mpox cases in Toronto, Ottawa, Peterborough, Kingston, Peel, Wellington-Dufferin-Guelph, Middlesex-London, Halton region, Brant County, Hamilton, and Haldimand-Norfolk PHUs ([[EQUATION]]). Higher rates of Mpox infection in Ontario were associated with ethnic concentration (racialized, migrants or visible minority) [[EQUATION]]), and male gender ( [[EQUATION]]) and residential instability ( ). Conclusion: We identified major Mpox hotspots in Toronto. According to our model results, the high incidence rate may be influenced by the greater population of internal migrant population and younger individuals. Based on these insights, we recommend targeted interventions in the high-risk neighborhoods. Efforts to improve Mpox diagnosis and promote health equity among socioeconomically vulnerable populations, including racial and ethnic minorities, should be implemented.

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Which Curve Are We Flattening? The Disproportionate Impact of COVID-19 Among Economically Marginalized Communities in Ontario, Canada, Was Unchanged From Wild-Type to Omicron

Cited by 3 publications

References 21 publications

Use and misuse of research: Canada’s response to covid-19 and its health inequalities

Use and misuse of research: Canada’s response to covid-19 and its health inequalities

Social inequalities in COVID-19 deaths by area-level income: patterns over time and the mediating role of vaccination in a population of 11.2 million people in Ontario, Canada

Geographical distribution and the impact of socio-environmental indicators on incidence of Mpox in Ontario, Canada

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