Socioeconomic gradient in health and the covid-19 outbreak

Chung, Ronald; Dong, Dong; Li, Minnie Ming

doi:10.1136/bmj.m1329

Cited by 99 publications

(79 citation statements)

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“…Comparison with literature findings Primary care literature on the impact of the COVID-19 outbreak on primary care is still emerging; at present, it mainly consists of practice guidelines, for example on telephone or video consulting. 15 16 Reports on psychological 17 and socioeconomic repercussions 18 of lockdown measures present similar results and warnings to the ones our GPs expressed. Several reports 19 20 describe the profound effect of the outbreak on the psychological well-being of healthcare professionals, in accordance with effects seen in previous outbreaks.…”

Section: Strengths and Limitationssupporting

confidence: 54%

Impact of the COVID-19 pandemic on the core functions of primary care: will the cure be worse than the disease? A qualitative interview study in Flemish GPs

et al. 2020

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ObjectivesThe current COVID-19 pandemic, as well as the measures taken to control it, have a profound impact on healthcare. This study was set up to gain insights into the consequences of the COVID-19 outbreak on the core competencies of general practice, as they are experienced by general practitioners (GPs) on the frontline.Design, setting, participantsWe performed a descriptive study using semistructured interviews with 132 GPs in Flanders, using a topic list based on the WONCA definition of core competencies in general practice. Data were analysed qualitatively using framework analysis.ResultsChanges in practice management and in consultation strategies were quickly adopted. There was a major switch towards telephone triage and consults, for covid-related as well as for non-covid related problems. Patient-centred care is still a major objective. Clinical decision-making is largely focused on respiratory assessment and triage, and GPs feel that acute care is compromised, both by their own changed focus and by the fact that patients consult less frequently for non-covid problems. Chronic care is mostly postponed, and this will have consequences that will extend and become visible after the corona crisis. Through the holistic eyes of primary care, the current outbreak—as well as the measures taken to control it—will have a profound impact on psychological and socioeconomic well-being. This impact is already visible in vulnerable people and will continue to become clear in the medium and long terms. GPs think that they are at high risk of getting infected. Dropping out and being unable to contribute their part or becoming virus transmitters are reported to be greater concerns than getting ill themselves.ConclusionsThe current times have a profound impact on the core competences of primary care. Although the vast increase in patients soliciting medical help and the necessary separate covid and non-covid flows have been dealt with, GPs are worried about the continuity of regular care and the consequences of the anticovid measures. These may become a threat for the general health of the population and for the provision of primary healthcare in the near and distant future.

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Section: Strengths and Limitationssupporting

confidence: 54%

Impact of the COVID-19 pandemic on the core functions of primary care: will the cure be worse than the disease? A qualitative interview study in Flemish GPs

et al. 2020

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“…There is a notable difference between respiratory cases and deaths, which may suggest that the profile of individuals who have the economic or social capital to seek care early for respiratory symptoms in Tijuana differs from those who do not interact with the medical system until after their death. This finding adds to a growing body of literature and social commentary suggesting that social inequalities may be translating into inequalities in the risk of infection or death from COVID-19 in numerous contexts [37][38][39][40][41][42][43] Conclusions EMS data provide a valuable tool to rapidly track the health of populations at risk of COVID-19 in LMICs, where other forms of real-time data may not be available. EMS information can be used to track excess out-of-hospital mortality and respiratory burden, as well as changing clinical or demographic features.…”

Section: Discussionmentioning

confidence: 79%

Excess Out-Of-Hospital Mortality and Declining Oxygen Saturation: The Sentinel Role of EMS Data in the COVID-19 Crisis in Tijuana, Mexico

Friedman

Calderón-Villarreal

Bojorquez

et al. 2020

Preprint

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Objective: Emergency medical services (EMS) may serve as a key source of real-time data about the evolving health of COVID-19 affected populations, especially in low-and-middle-income countries (LMICs) with less rapid and reliable vital statistic registration systems. Although official COVID-19 statistics in Mexico report almost exclusively in-hospital mortality events, excess out-of-hospital mortality has been identified in other settings, including one EMS study in Italy that showed a 58% increase. EMS and hospital reports from several countries have suggested that silent hypoxemia-low oxygen saturation (SpO2) in the absence of dyspnea-is associated with COVID-19 outbreaks. It is unclear, however, how these phenomena can be generalized to LMICs. We assess how EMS data can be used in a sentinel capacity in Tijuana, a city on the Mexico-United States border with earlier exposure to COVID-19 than many LMIC settings. Methods:We calculated numbers of weekly out-of-hospital deaths and respiratory cases seen by EMS in Tijuana, and estimate the difference between peak-epidemic rates (during April 14 th -May 11 th ) and forecasted 2014-2019 trends. Results were compared with official COVID-19 statistics, stratified by neighborhood socioeconomic status (SES), and examined for changing demographic or clinical features, including mean (SpO2).Results: An estimated 194.7 (95%CI: 135.5-253.9) excess out-of-hospital deaths events occurred, representing an increase of 145% (70%-338%) compared to forecasted trends. During the same window, only 8 COVID-19-positive, out-of-hospital deaths were reported in official statistics. This corresponded with a rise in respiratory cases of 274% (119%-1142%), and a drop in mean SpO2 to 77.7%, from 90.2% at baseline. The highest out-of-hospital death rates were observed in low-SES areas, although respiratory cases were more concentrated in high-SES areas.Conclusions: EMS systems may play an important sentinel role in monitoring excess out-of-hospital mortality and other trends during the COVID-19 crisis in LMICs. Using EMS data, we observed increases in out-of-hospital deaths in Tijuana that were nearly threefold greater magnitude than increases reported using EMS data in Italy. Increased testing in out-of-hospital settings may be required to determine if excess mortality is being driven by COVID-19 infection, health system saturation, or patient avoidance of healthcare. We also found evidence of worsening rates of hypoxemia among respiratory patients seen by EMS, suggesting a rise in silent hypoxemia, which should be met with increased detection and clinical management efforts. Finally, we observed that social disparities in out-of-hospital death that warrant monitoring and amelioration.

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“…Gender and education are important socio-demographic factors related to protective behavior. It is known that there is a socioeconomic gradient, resulting in social and health inequalities related to the COVID-19 outbreak (20,21). In particular, socioeconomic characteristics like lower income and lower education are associated with an increased risk of COVID-19 related mortality (22,23), which stresses the necessity to reduce health inequalities (24).…”

Section: Summary Of Main Findingsmentioning

confidence: 99%

Protective Behavior in Course of the COVID-19 Outbreak—Survey Results From Germany

Lüdecke

Knesebeck

2020

Front. Public Health

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Objective: The COVID-19 outbreak means far-reaching changes in the organization of daily lives. Disease-related literacy and factors such as age, gender, or education play a major role in shaping individual practices of protective behavior. This paper investigates different types and frequency of practicing protective behaviors, as well as socio-demographic factors that are associated with such behavioral change. Methods: Data stem from a cross-sectional survey in Germany. Three thousand seven hundred and sixty-five people were contacted, 3,186 participated in the survey. Information on behavior to lower the risk of becoming infected with COVID-19 was assessed by nine items (answer options yes/no). For each item, logistic regression models were used to estimate odds ratios (OR), using education, sex, and age as main predictors and adjusting for partnership status and household composition. Results: People with lower educational level were less likely to avoid gatherings (OR = 0.63; 95%CI = 0.48-0.83), adapt their work situation (OR = 0.66; 95%CI = 0.52-0.82), reduce personal contacts and meetings (OR = 0.71; 95%CI = 0.55-0.93), or increase hand hygiene (OR = 0.53; 95%CI = 0.38-0.73). Being female was associated with higher odds of protective behavior for most outcomes. Exceptions were wearing face masks and adapting the own work situation. Associations between respondents' age and individual behavior change were inconsistent and mostly weak. Conclusion: Disease specific knowledge is essential in order to enable people to judge information on COVID-19. Health education programs aiming at improving COVID-19 knowledge are helpful to build up appropriate practices and reduce the spread of the disease. Strategies are needed to guarantee easy access and better dissemination of high-quality news and fact-checks. Socioeconomic characteristics should be taken into account in the development of infection control measures.

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Socioeconomic gradient in health and the covid-19 outbreak

Cited by 99 publications

References 1 publication

Impact of the COVID-19 pandemic on the core functions of primary care: will the cure be worse than the disease? A qualitative interview study in Flemish GPs

Impact of the COVID-19 pandemic on the core functions of primary care: will the cure be worse than the disease? A qualitative interview study in Flemish GPs

Excess Out-Of-Hospital Mortality and Declining Oxygen Saturation: The Sentinel Role of EMS Data in the COVID-19 Crisis in Tijuana, Mexico

Protective Behavior in Course of the COVID-19 Outbreak—Survey Results From Germany

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