Impact of socioeconomic status on the clinical outcomes in hospitalised patients with SARS-CoV-2 infection: a retrospective analysis

Abstract

Aim A disadvantaged socioeconomic status (SES) was previously associated with higher incidence and poor outcomes both of non-communicable diseases (NCDs) and infectious diseases. Inequalities in health services also have a negative effect on the coronavirus disease 2019 (COVID-19) morbidity and mortality. Subject and methods The study analysed the role of SES measured by the educational level (EL) in hospitalised patients with COVID-19 between 9 March 2020 and 20 September 2021 at our centre of infectious diseases. Clinical outcomes were: length of hospitalisation, in-hospital mortality and the need of intensive-care-unit (ICU) support. Results There were 566 patients included in this retrospective analysis. Baseline EL was: illiterate (5, 0.9%), primary school (99, 17.5%), secondary school (228, 40.3%), high school (211, 37.3%), degree (23, 4.1%); median age was higher in low EL (72.5 years vs 61 years, p = 0.003), comorbidity (56% in low EL, 34.6% in high EL, p < 0.001), time from the symptoms and PCR diagnosis (8.5 days in low EL, 6.5 days in high EL, p < 0.001), hospitalisation length (11.5 days in low EL, 9.5 days in high EL, p = 0.011), mortality rate (24.7% in low EL, 13.2% in high EL, p < 0.001). In the multivariate analysis there were predictors of mortality: age (OR = 4.981; 95%CI 2.172–11.427; p < 0.001), comorbidities (OR = 3.227; 95%CI 2.515–11.919; p = 0.007), ICU admission (OR = 6.997; 95%CI 2.334–31.404; p = 0.011), high vs low EL (OR = 0.761; 95%CI 0.213–0.990; p = 0.021). In survival analysis, higher EL was associated with a decreased risk of mortality up to 23.9%. Conclusion Even though the EL is mainly related to the age of patients, in our analysis, it resulted as an independent predictor of in-hospital mortality and hospitalisation time. Unfortunately, this is a study focused only on hospitalised patients, and we did not examine the possible effect of EL in outpatients. Further analyses are required to confirm this suggestion and provide novel information.

Family socioeconomic position and changes in planned health care for children with chronic diseases during the COVID-19 pandemic in Italy

“…This proportion was higher for children requiring more visits in the pre-pandemic period and for those living in lower-income families. It has been documented that the COVID-19 pandemic disproportionately affected population strata characterized by low SEP, with higher risks of hospitalizations and adverse health outcomes ( 9 , 10 ). Furthermore, the negative effects of lockdown measures, such as reduced income or job loss, have been shown to affect the most vulnerable population, including people with a lower SEP ( 11 ).…”

COVID-19 inequalities in England: a mathematical modelling study of transmission risk and clinical vulnerability by socioeconomic status

“…Morbidity and the presence of underlying health conditions tend to vary greatly by socioeconomic status (SES), and are a significant risk factor for severe infection [8]. Vulnerability to more severe infection has both direct effects, including a greater risk of consequential long-term health complications and greater mortality risk, and indirect population-level effects, such as potentially increased infectiousness of symptomatic cases.…”

“…Morbidity and the presence of underlying health conditions tend to vary greatly by socioeconomic status (SES), and are a significant risk factor for severe infection [8].…”

COVID-19 inequalities in England: a mathematical modelling study of transmission risk and clinical vulnerability by socioeconomic status

“…Morbidity and the presence of underlying health conditions tend to vary greatly by socioeconomic status (SES) and are a significant risk factor for severe infection [8]. Vulnerability to more severe infection has both direct effects, including a greater risk of consequential longterm health complications and greater mortality risk, and indirect population-level effects, such as potentially increased infectiousness of symptomatic cases.…”