The association between socioeconomic status and pandemic influenza: protocol for a systematic review and meta-analysis

Abstract

BackgroundPandemic mortality rates in 1918 and in 2009 were highest among those with the lowest socioeconomic status (SES). Despite this, low SES groups are not included in the list of groups prioritized for pandemic vaccination, and the ambition to reduce social inequality in health does not feature in international and national pandemic preparedness plans. We describe plans for a systematic review and meta-analysis of the association between SES and pandemic outcomes during the last five pandemics.MethodThe planned review will cover studies of pandemic influenza that report associations between morbidity, hospitalization, or mortality with socioeconomic factors such as education and income. The review will include published studies in the English, Danish, Norwegian, and Swedish languages, regardless of geographical location. Relevant records were identified through systematic literature searches in MEDLINE, Embase, Cinahl, SocIndex, Scopus, and Web of Science. Reference lists of relevant known studies will be screened and experts in the field consulted in order to identify other additional sources. Two investigators will independently screen and select studies, and discrepancies will be resolved through discussion until consensus is reached. Covidence will be used. Results will be summarized narratively and using three meta-analytic strategies: coefficients expressing the difference between the highest and lowest socioeconomic groups reported will be pooled using (a) fixed and random effects meta-analysis where studies involve similar outcome and exposure measures and (b) meta-regression where studies involve similar outcome measures. In addition, we will attempt to use all reported estimates for SES differences in (c) a Bayesian meta-analysis to estimate the underlying SES gradient and how it differs by outcome and exposure measure.DiscussionThis study will provide the first systematic review of research on the relation between SES and pandemic outcomes. The findings will be relevant for health policy in helping to assess whether people of low socioeconomic status should be prioritized for vaccines in preparedness plans for pandemic influenza. The review will also contribute to the research literature by providing pooled estimates of effect sizes as inputs into power calculations of future studies.Systematic review registration PROSPERO 87922

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“…This highlights the need for consistent approaches across jurisdictions to collect this information systematically and completely. As with influenza mortality rates, differences in socioeconomic factors might have contributed to elevated COVID-19 mortality ( 5 ). Financial or transportation-related barriers to health care access might have prevented patients from receiving timely medical care at the time of initial evaluation, resulting in more severe illness that was less amenable to treatment ( 2 ).…”

Air quality during the COVID-19: PM2.5 analysis in the 50 most polluted capital cities in the world

“…For example, in Brisbane, Australia ecological factors appear to have played an important role in H1N1 transmission cycles (Hu et al, 2012), with temperature and precipitation being substantial variables in the evolution of the virus. There are some other works of socioeconomic studies and viruses such as (Mamelund et al, 2019), where a study is carried out between the socioeconomic levels and the influenza-related pandemics of 1918 and 2009. The foregoing demonstrates the importance of correlating the factors that can substantially alter the socio-ecological systems in which we live and to be able to study their evolution and impact on society.…”

Meta‐regression of COVID‐19 prevalence/fatality on socioeconomic characteristics of data from top 50 U.S. large cities

“…It has been suggested that outcomes of pandemic influenza are associated with socioeconomic status. 1 Results of the meta-regression were summarized in Table 1.…”