Ethnic inequalities in positive SARS-CoV-2 tests, infection prognosis, COVID-19 hospitalisations, and deaths : analysis of two years of a record linked national cohort study in Scotland

Funding: Economics and Social Research Council (ESRC) ES/W000849/1, Medical Research Council (MRC) MC_UU_00022/2, Scottish Government Chief Scientist Office SPHSU17.BACKGROUND: This study aims to estimate ethnic inequalities in risk for positive SARS-CoV-2 tests, COVID-19 hospitalisations and deaths over time in Scotland. METHODS: We conducted a population-based cohort study where the 2011 Scottish Census was linked to health records. We included all individuals≥16 years living in Scotland on 1 March 2020. The study period was from 1 March 2020 to 17 April 2022. Self-reported ethnic group was taken from the census and Cox proportional hazard models estimated HRs for positive SARS-CoV-2 tests, hospitalisations and deaths, adjusted for age, sex and health board. We also conducted separate analyses for each of the four waves of COVID-19 to assess changes in risk over time. FINDINGS: Of the 4 358 339 individuals analysed, 1 093 234 positive SARS-CoV-2 tests, 37 437 hospitalisations and 14 158 deaths occurred. The risk of COVID-19 hospitalisation or death among ethnic minority groups was often higher for White Gypsy/Traveller (HR 2.21, 95% CI (1.61 to 3.06)) and Pakistani 2.09 (1.90 to 2.29) groups compared with the white Scottish group. The risk of COVID-19 hospitalisation or death following confirmed positive SARS-CoV-2 test was particularly higher for White Gypsy/Traveller 2.55 (1.81-3.58), Pakistani 1.75 (1.59-1.73) and African 1.61 (1.28-2.03) individuals relative to white Scottish individuals. However, the risk of COVID-19-related death following hospitalisation did not differ. The risk of COVID-19 outcomes for ethnic minority groups was higher in the first three waves compared with the fourth wave. INTERPRETATION: Most ethnic minority groups were at increased risk of adverse COVID-19 outcomes in Scotland, especially White Gypsy/Traveller and Pakistani groups. Ethnic inequalities persisted following community infection but not following hospitalisation, suggesting differences in hospital treatment did not substantially contribute to ethnic inequalities.Publisher PDFPeer reviewe

Socioeconomic inequalities in health. Evidence from Italy before and during the SARS-CoV-2 pandemic

In this thesis I try to understand, describe and find evidence about health differentials in Italy before and during the COVID-19 pandemic started in 2020. This thesis is composed of an introductory chapter and three chapters that will focus on different facets of health inequalities. The first section will give an overview of the existing literature on the topic, describing previous methodologies, definitions, and findings about inequalities in Europe and Italy. It will end by introducing the research questions I answered in the subsequent chapters. The second chapter brings new evidence about health inequalities in Rome before the COVID-19 pandemic, focusing on both individual and area-level differences. The third section will show how different levels of economic disadvantage shaped the transmission of the SARS-CoV-2 virus, in a period of differential restrictions. The fourth chapter will disentangle the effect of area-level deprivation and pre-existent chronic conditions on COVID-19 mortality. I will end the thesis with a short conclusion, discussing my main findings and their implications

County-Level Factors That Influenced the Trajectory of COVID-19 Incidence in the New York City Area

More than a century of research has shown that sociodemographic conditions affect infectious disease transmission. In the late spring and early summer of 2020, reports of the effects of sociodemographic variables on the spread of COVID- 19 were used in the media with minimal scientific proof attached. With new cases of COVID-19 surging in the United States at that time, it became essential to better understand how the spread of COVID-19 was varying across all segments of the population. We used hierarchical exponential growth curve modeling techniques to examine whether community socioeconomic characteristics uniquely influence the incidence of reported COVID-19 cases in the urban built environment. We show that as of July 19, 2020, confirmed coronavirus infections in New York City and surrounding areas— one of the early epicenters of the COVID-19 pandemic in the United States—were concentrated along demographic and socioeconomic lines. Furthermore, our data provides evidence that after the onset of the pandemic, timely enactment of physical distancing measures such as school closures was essential to limiting the extent of the coronavirus spread in the population. We conclude that in a pandemic, public health authorities must impose physical distancing measures early on as well as consider community-level factors that associate with a greater risk of viral transmission

The Use of Penalized Regression Analysis to Identify County-Level Demographic and Socioeconomic Variables Predictive of Increased COVID-19 Cumulative Case Rates in the State of Georgia

Systemic inequity concerning the social determinants of health has been known to affect morbidity and mortality for decades. Significant attention has focused on the individual-level demographic and co-morbid factors associated with rates and mortality of COVID-19. However, less attention has been given to the county-level social determinants of health that are the main drivers of health inequities. To identify the degree to which social determinants of health predict COVID-19 cumulative case rates at the county-level in Georgia, we performed a sequential, cross-sectional ecologic analysis using a diverse set of socioeconomic and demographic variables. Lasso regression was used to identify variables from collinear groups. Twelve variables correlated to cumulative case rates (for cases reported by 1 August 2020) with an adjusted r squared of 0.4525. As time progressed in the pandemic, correlation of demographic and socioeconomic factors to cumulative case rates increased, as did number of variables selected. Findings indicate the social determinants of health and demographic factors continue to predict case rates of COVID-19 at the county-level as the pandemic evolves. This research contributes to the growing body of evidence that health disparities continue to widen, disproportionality affecting vulnerable populations

Occupation, Work-Related Exposure, and SARS-CoV-2 Transmission

Background: Early evidence from the Coronavirus Disease 2019 (COVID-19) pandemic suggests that workers differ in their risk of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection and adverse outcomes according to their occupation. The direct contribution of occupation to these inequalities in unclear, given a lack of comprehensively-adjusted estimates. Potential work-related mechanisms underlying differential risk are also poorly understood. / Objectives: This thesis aimed to investigate (1) how SARS-CoV-2 infection risk and (2) features of work-related contact varied between occupations and over time, (3) whether work-related contact mediated the relationship between occupation and infection risk, (4) how vaccination uptake varied across occupations overall and according to vulnerability status and work-related exposure, and (5) how implementation and perception of pandemic mitigation methods varied between occupations and over time. / Methods: All analyses were conducted using data from Virus Watch, a community prospective cohort study in England and Wales. Infection outcomes and vaccination status were ascertained based on linkage, weekly participant self-report, and – for infection outcomes – virological and serological testing within the study. Measures were developed to investigate workplace contact patterns and mitigations. / Results: Frontline workers from several sectors had elevated infection risk compared to office-based professional occupations. Differential risk was most marked in early waves, and only teaching, education, and childcare workers demonstrated elevated risk across all waves. Groups with elevated infection risk also tended to demonstrate greater workplace contact and exposure and, often, lower reporting of mitigations. Work-related close contact was a mediator of infection risk. Occupational differences in vaccination uptake emerged primarily amongst non-vulnerable workers. Workers had a high level of agreement with most mitigations. / Conclusions: Occupation is an important factor influencing SARS-CoV-2 infection risk. Workers differed substantially in workplace exposure, vaccination uptake, and work-related mitigations. Evidence-based suggestions for research and practice are made regarding pandemic preparation and endemic SARS-CoV-2 transmission

SARS-CoV-2 transmission dynamics should inform policy

Funding: JM is supported in part by the U.S. National Institute of Allergy and Infectious Diseases [K01AI122853].It is generally agreed that striking a balance between resuming economic and social activities and keeping the effective reproductive number (R0) below 1 using non-pharmaceutical interventions is an important goal until and even after effective vaccines become available. Therefore, the need remains to understand how the virus is transmitted in order to identify high-risk environments and activities that disproportionately contribute to its spread so that effective preventative measures could be put in place. Contact tracing and household studies in particular provide robust evidence about the parameters of transmission. In this viewpoint, we discuss the available evidence from large-scale, well-conducted contact tracing studies from across the world and argue that SARS-CoV-2 transmission dynamics should inform policy decisions about mitigation strategies for targeted interventions according to the needs of the society by directing attention to the settings, activities and socioeconomic factors associated with the highest risks of transmission.PostprintPeer reviewe

Spatial Analysis of the COVID-19 Pandemic in Hungary: Changing Epidemic Waves in Time and Space

This paper examines the spatial dynamics and regional distribution of the novel coronavirus epidemic in Hungary in an effort to obtain a deeper understanding of the connection between space and health. The paper also presents comprehensive epidemiologic data on the spatiotemporal spread of the COVID-19 pandemic in terms of the epidemic waves. Following a comparison of the growth rates of infection numbers, the current study explores the geographical dimension of the three pandemic waves. The partial transformation of spatial characteristics during the three epidemic waves is among the most important results found. While geographical hotspots influenced the first wave, newly confirmed coronavirus cases in the second and third waves were due to community-based epidemic spreading. Furthermore, the western-eastern spatial relation and the core-periphery model also affected the regional distribution of new cases and deaths in the initial two waves. However, a new spatial pattern - realised by the northern-southern spatial orientation - appeared during the third wave. The outputs of this paper offer feasible suggestions for evidence-based policymaking in pandemic prevention, mitigation, and preparedness

COVID-19 and the gendered markets of people and products: explaining inequalities in infections and death

COVID-19 has exposed and exploited existing inequalities in gender to drive inequities in health outcomes. Evidence illustrates the relationship between occupation, ethnicity and gender to increase risk of infection in some places. Higher death rates are seen among people also suffering from non-communicable diseases – e.g. heart disease and lung disease driven by exposure to harmful patterns of exposure to corporate products (tobacco, alcohol, ultra-processed foods), corporate by-products (e.g. outdoor air pollution) or gendered corporate processes (e.g. gendered occupational risk). The paper argues that institutional gender blindness in the health system means that underlying gender inequalities have not been taken into consideration in policies and programmatic responses to COVID-19

Antimicrobial resistance and COVID-19: Intersections and implications

Before the coronavirus 2019 (COVID-19) pandemic began, antimicrobial resistance (AMR) was among the top priorities for global public health. Already a complex challenge, AMR now needs to be addressed in a changing healthcare landscape. Here, we analyse how changes due to COVID-19 in terms of antimicrobial usage, infection prevention, and health systems affect the emergence, transmission, and burden of AMR. Increased hand hygiene, decreased international travel, and decreased elective hospital procedures may reduce AMR pathogen selection and spread in the short term. However, the opposite effects may be seen if antibiotics are more widely used as standard healthcare pathways break down. Over 6 months into the COVID-19 pandemic, the dynamics of AMR remain uncertain. We call for the AMR community to keep a global perspective while designing finely tuned surveillance and research to continue to improve our preparedness and response to these intersecting public health challenges