Socioeconomic position and the COVID-19 care cascade from testing to mortality in Switzerland: a population-based analysis
Open accessAbstract
BACKGROUND: The inverse care law states that disadvantaged populations need more health care than advantaged populations but receive less. Gaps in COVID-19-related health care and infection control are not well understood. We aimed to examine inequalities in health in the care cascade from testing for SARS-CoV-2 to COVID-19-related hospitalisation, intensive care unit (ICU) admission, and death in Switzerland, a wealthy country strongly affected by the pandemic. METHODS: , education and occupation of household heads, and crowding. We used negative binomial regression models to calculate incidence rate ratios (IRRs) with 95% credible intervals (CrIs) of the association between ten groups of the Swiss-SEP index defined by deciles (1=lowest, 10=highest) and outcomes. Models were adjusted for sex, age, canton, and wave of the epidemic (before or after June 8, 2020). We used three different denominators: the general population, the number of tests, and the number of positive tests. FINDINGS: Analyses were based on 4 129 636 tests, 609 782 positive tests, 26 143 hospitalisations, 2432 ICU admissions, 9383 deaths, and 8 221 406 residents. Comparing the highest with the lowest Swiss-SEP group and using the general population as the denominator, more tests were done among people living in neighbourhoods of highest SEP compared with lowest SEP (adjusted IRR 1·18 [95% CrI 1·02-1·36]). Among tested people, test positivity was lower (0·75 [0·69-0·81]) in neighbourhoods of highest SEP than of lowest SEP. Among people testing positive, the adjusted IRR was 0·68 (0·62-0·74) for hospitalisation, was 0·54 (0·43-0·70) for ICU admission, and 0·86 (0·76-0·99) for death. The associations between neighbourhood SEP and outcomes were stronger in younger age groups and we found heterogeneity between areas. INTERPRETATION: The inverse care law and socioeconomic inequalities were evident in Switzerland during the COVID-19 epidemic. People living in neighbourhoods of low SEP were less likely to be tested but more likely to test positive, be admitted to hospital, or die, compared with those in areas of high SEP. It is essential to continue to monitor testing for SARS-CoV-2, access and uptake of COVID-19 vaccination and outcomes of COVID-19. Governments and health-care systems should address this pandemic of inequality by taking measures to reduce health inequalities in response to the SARS-CoV-2 pandemic. FUNDING: Swiss Federal Office of Public Health, Swiss National Science Foundation, EU Horizon 2020, Branco Weiss Foundation.
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Social inequalities in COVID-19 deaths were evident during the early pandemic period across the world.
“Social inequalities in COVID-19 deaths were evident during the early pandemic period across the world(2-8).”
Residual heightened risk in COVID-19 deaths by lower-income neighbourhoods might reflect a combination of higher exposure risks associated with individual-level occupation and housing conditions not fully captured by area-level measures, and poorer access to and quality of prevention and treatment interventions, including testing and anti-virals.
“Thus, residual heightened risk in COVID-19 deaths by lower-income neighbourhoods might reflect a combination of higher exposure risks associated with individual-level occupation and housing conditions that are not fully captured by area-level measures, and poorer access to and quality of prevention and treatment interventions, including testing(2,62,63) and anti-virals(64).”
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References 33 · Cited by 136
Research works printed but not linked: 26
- [4]Hart JT The inverse care law Lancet 1 1971 405 412 4100731
- [5]The Lancet 50 years of the inverse care law Lancet 397 2021 767 33640043
- [6]Mackenbach JP Stirbu I Roskam AJ Socioeconomic inequalities in health in 22 European countries N Engl J Med 358 2008 2468 2481 18525043
- [7]Moser A Panczak R Zwahlen M What does your neighbourhood say about you? A study of life expectancy in 1·3 million Swiss neighbourhoods J Epidemiol Community Health 68 2014 1125 1132 25124188
- [8]Khalatbari-Soltani S Cumming RC Delpierre C Kelly-Irving M Importance of collecting data on socioeconomic determinants from the early stage of the COVID-19 outbreak onwards J Epidemiol Community Health 74 2020 620 623 32385126 PMC7298202
- [9]McQueenie R Foster HME Jani BD Multimorbidity, polypharmacy, and COVID-19 infection within the UK Biobank cohort PLoS One 15 2020 e0238091 PMC7440632 32817712
- [10]Ward H Atchison C Whitaker M SARS-CoV-2 antibody prevalence in England following the first peak of the pandemic Nat Commun 12 2021 905 33568663 PMC7876103
- [11]Quan D Luna Wong L Shallal A Impact of race and socioeconomic status on outcomes in patients hospitalized with COVID-19 J Gen Intern Med 36 2021 1302 1309 33506402 PMC7840076
- [12]Ossimetha A Ossimetha A Kosar CM Rahman M Socioeconomic disparities in community mobility reduction and COVID-19 growth Mayo Clin Proc 96 2021 78 85 33413837 PMC7580696
- [16]Panczak R Galobardes B Voorpostel M Spoerri A Zwahlen M Egger M A Swiss neighbourhood index of socioeconomic position: development and association with mortality J Epidemiol Community Health 66 2012 1129 1136 22717282 PMC5204371
- [17]Gelman A Hill J Vehtari A Regression and other stories 2020 Cambridge University Press Cambridge
- [19]Zhou F Yu T Du R Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study Lancet 395 2020 1054 1062 32171076 PMC7270627
- [20]Peckham H de Gruijter NM Raine C Male sex identified by global COVID-19 meta-analysis as a risk factor for death and ITU admission Nat Commun 11 2020 6317 PMC7726563 33298944
- [21]Griffith GJ Morris TT Tudball MJ Collider bias undermines our understanding of COVID-19 disease risk and severity Nat Commun 11 2020 5749 PMC7665028 33184277
- [22]Panczak R Berlin C Voorpostel M Zwahlen M Egger M The Swiss-SEP neighbourhood index of socioeconomic position: update OSF Preprints 2021 published online June 17. 10.31219/osf.io/py9tz (preprint). 36652707 · DOI
- [24]Dryden-Peterson S Velásquez GE Stopka TJ Davey S Lockman S Ojikutu BO Disparities in SARS-CoV-2 testing in Massachusetts during the COVID-19 pandemic JAMA Netw Open 4 2021 e2037067 PMC7873783 33560423
- [25]Stringhini S Wisniak A Piumatti G Seroprevalence of anti-SARS-CoV-2 IgG antibodies in Geneva, Switzerland (SEROCoV-POP): a population-based study Lancet 396 2020 313 319 32534626 PMC7289564
- [26]Richard A Wisniak A Perez-Saez J Seroprevalence of anti-SARS-CoV-2 IgG antibodies, risk factors for infection and associated symptoms in Geneva, Switzerland: a population-based study medRxiv 2020 published online Dec 18. 10.1101/2020.12.16.20248180 (preprint). PMC8808008 34664529 · DOI
- [27]Drefahl S Wallace M Mussino E A population-based cohort study of socio-demographic risk factors for COVID-19 deaths in Sweden Nat Commun 11 2020 5097 PMC7547672 33037218
- [28]Mathur R Rentsch CT Morton CE Ethnic differences in SARS-CoV-2 infection and COVID-19-related hospitalisation, intensive care unit admission, and death in 17 million adults in England: an observational cohort study using the OpenSAFELY platform Lancet 397 2021 1711 1724 33939953 PMC8087292
- [29]Victora CG Vaughan JP Barros FC Silva AC Tomasi E Explaining trends in inequities: evidence from Brazilian child health studies Lancet 356 2000 1093 1098 11009159
- [30]Incerti D Rizzo S Li X Prognostic model to identify and quantify risk factors for mortality among hospitalised patients with COVID-19 in the USA BMJ Open 11 2021 e047121 PMC8029269 33827848
- [31]Garnier R Benetka JR Kraemer J Bansal S Socioeconomic disparities in social distancing during the COVID-19 pandemic in the United States: observational study J Med Internet Res 23 2021 e24591 PMC7837167 33351774
- [34]Biller-Andorno N Zeltner T Individual responsibility and community solidarity—the Swiss health care system N Engl J Med 373 2015 2193 2197 26630139
- [35]Guessous I Gaspoz JM Theler JM Wolff H High prevalence of forgoing healthcare for economic reasons in Switzerland: a population-based study in a region with universal health insurance coverage Prev Med 55 2012 521 527 22940614
- [36]Sirleaf EJ Clark H Report of the Independent Panel for Pandemic Preparedness and Response: making COVID-19 the last pandemic Lancet 2021 published online May 12. 10.1016/S0140-6736(21)01095-3 PMC9751704 33991477 · DOI · Paper page
- Authors
- Riou, J., Panczak, R., Althaus, C. L., Junker, C., Perisa, D., Schneider, K., Criscuolo, N. G., Low, N., & Egger, M.
- Affiliations
- University of Bern (CH)
- Federal Office of Public Health (CH)
- ETH Zurich (CH)
- Corresponding author
- Egger, Matthias
- ORCID
- Venue
- The Lancet Public Health
- Publisher
- Elsevier BV
- Published
- 2021-09
- Volume
- 6
- Issue
- 9
- Pages
- e683-e691
- ISSN
- 2468-2667 (ISSN-L)
- PMC
- PMC8270761
- OpenAlex
- W3182553904
- Cited by
- 136
- References
- 33
- Citations by year
- 2026: 8 · 2025: 24 · 2024: 27 · 2023: 33 · 2022: 41 · 2021: 3
- FWCI
- 14.36
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- The Lancet Public Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Bristol Research (University of Bristol) (publishedVersion, cc-by)
- BORIS (University Library Bern) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Explore Bristol Research (submittedVersion, cc-by)
- Repository for Publications and Research Data (ETH Zurich) (submittedVersion, cc-by)
- ETH Zürich Research Collection (cc-by)
- Open Access CRIS of the University of Bern
- Funders
- Horizon 2020
- Swiss National Science Foundation
- Topics
- Social Sciences › Health › Health disparities and outcomes
- Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Keywords
- COVID-19 pandemic, socioeconomic inequalities in health, cascade of care, COVID-19 testing, test positivity, hospitalization, intensive care unit admission, COVID-19 mortality, inverse care law, health disparities, Switzerland, household crowding
- MeSH terms
- COVID-19, COVID-19 Testing, Adolescent, Adult, Aged, Aged, 80 and over, Child, Child, Preschool, Female, Hospitalization, Humans, Infant, Infant, Newborn, Intensive Care Units, Male, Middle Aged, Social Class, Switzerland, Healthcare Disparities, Young Adult
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