Impact of Social Deprivation on Hospitalization and Intensive Care Unit Admission among COVID-19 Patients: A Systematic Review and Meta-Analysis
Abstract
Background: The coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected socially disadvantaged groups; however, the association between socioeconomic status and healthcare utilization among COVID-19 patients remains unclear. Therefore, a systematic review and meta-analysis was conducted to assess the association between socioeconomic status and hospitalization and intensive care unit admission among COVID-19 patients.
Methods: PubMed, Embase, and the Cochrane Register of Controlled Trials were searched for relevant literature (updated to Jun 2022). Studies that investigated the association of social deprivation with hospitalization and intensive care unit admission in COVID-19 patients were included. The primary outcomes included risk of hospitalization and intensive care unit admission, measured by odds ratio.
Results: Eleven studies covering 2,423,095 patients were included in the meta-analysis. Socially disadvantaged patients had higher odds of hospitalization in comparison to socially advantaged patients (odds ratio 1.25, 95% confidence interval: 1.14 to 1.38; P<0.01). The odds of intensive care unit admission among more deprived patients was not significantly different from that of less deprived patients (odds ratio 1.03, 95% confidence interval: 0.78 to 1.35; P=0.85). These findings were proven robust through subgroup and sensitivity analyses.
Conclusion: Socially disadvantaged populations have higher odds of hospitalization if they become infected with COVID-19. More effective medical support and interventions for these vulnerable populations are required to reduce inequity in healthcare utilization and alleviate the burden on healthcare systems.
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6. Mude W, Oguoma VM, Nyanhanda T, et al. (2021). Racial disparities in COVID-19 pandemic cases, hospitalisations, and deaths: A systematic review and meta-analysis. J Glob Health,11:05015.
7. Liaw W, Krist AH, Tong ST, et al. (2018). Living in "Cold Spot" Communities Is Associated with Poor Health and Health Quality. J Am Board Fam Med,31(3):342-50.
8. Kind AJ, Jencks S, Brock J, et al. (2014). Neighborhood socioeconomic disadvantage and 30-day rehospitalization: a retrospective cohort study. Ann Intern Med,161(11):765-74.
9. Salmond C, Crampton P, Sutton F (1998). NZDep91: A New Zealand index of deprivation. Aust N Z J Public Health,22(7):835-7.
10. Zhang Y, Ancker JS, Hall J, et al. (2020). Association Between Residential Neighborhood Social Conditions and Health Care Utilization and Costs. Med Care,58(7):586-93.
11. Bray I, Gibson A, White J (2020). Coronavirus disease 2019 mortality: a multivariate ecological analysis in relation to ethnicity, population density, obesity, deprivation and pollution. Public Health,185:261-3.
12. Gu T, Mack JA, Salvatore M, et al. (2020). Characteristics Associated With Racial/Ethnic Disparities in COVID-19 Outcomes in an Academic Health Care System. JAMA Netw Open,3(10):e2025197.
13. Patel AP, Paranjpe MD, Kathiresan NP, et al. (2020). Race, socioeconomic deprivation, and hospitalization for COVID-19 in English participants of a national biobank. Int J Equity Health,19(1):114.
14. Beaumont AL, Vignes D, Sterpu R, et al. (2022). Factors associated with hospital admission and adverse outcome for COVID-19: Role of social factors and medical care. Infect Dis Now, 52(3):130-137.
15. Escobar GJ, Adams AS, Liu VX, et al. (2021). Racial Disparities in COVID-19 Testing and Outcomes: Retrospective Cohort Study in an Integrated Health System. Ann Intern Med,174(6):786-93.
16. Moher D, Liberati A, Tetzlaff J, et al. (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ,339:b2535.
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18. DerSimonian R, Laird N (2015). Meta-analysis in clinical trials revisited. Contemp Clin Trials,45(Pt A):139-45.
19. Ingraham NE, Purcell LN, Karam BS, et al. (2020). Racial and Ethnic Disparities in Hospital Admissions from COVID-19: Determining the Impact of Neighborhood Deprivation and Primary Language. J Gen Intern Med,36(11):3462-70.
20. Jefferies S, French N, Gilkison C, et al. (2020). COVID-19 in New Zealand and the impact of the national response: a descriptive epidemiological study. The Lancet Public Health,5(11):e612-e23.
21. Lewis NM, Friedrichs M, Wagstaff S, et al. (2020). Disparities in COVID-19 Incidence, Hospitalizations, and Testing, by Area-Level Deprivation - Utah, March 3-July 9, 2020. MMWR Morbidity and Mortality Weekly Report,69(38):1369-73.
22. Cummins L, Ebyarimpa I, Cheetham N, et al. (2021). Factors associated with COVID-19 related hospitalisation, critical care admission and mortality using linked primary and secondary care data. Influenza Other Respir Viruses,15(5):577-88.
23. Saatci D, Ranger TA, Garriga C, et al. (2021). Association Between Race and COVID-19 Outcomes Among 2.6 Million Children in England. JAMA Pediatrics,175(9):928-38.
24. Zhang Y, Khullar D, Wang F, et al. (2021). Socioeconomic variation in characteristics, outcomes, and healthcare utilization of COVID-19 patients in New York City. PLoS ONE,16(7):e0255171.
25. Abda A, Del Giorgio F, Gauvin L, et al. (2022). Association between area-level material deprivation and incidence of hospitalization among children with SARS-CoV-2 in Montreal. Paediatr Child Health,27(Suppl 1):S27-S32.
26. Beaney T, Neves AL, Alboksmaty A, et al. (2022). Trends and associated factors for Covid-19 hospitalisation and fatality risk in 2.3 million adults in England. Nat Commun,13(1):2356.
27. Walls M, Priem JS, Mayfield CA, et al. (2022). Disparities in Level of Care and Outcomes Among Patients with COVID-19: Associations Between Race/Ethnicity, Social Determinants of Health and Virtual Hospitalization, Inpatient Hospitalization, Intensive Care, and Mortality. J Racial Ethn Health Disparities, 15:1-11.
28. Wan YI, Apea VJ, Dhairyawan R, et al. (2022). Ethnic disparities in hospitalisation and hospital-outcomes during the second wave of COVID-19 infection in east London. Scientific Reports, 12(1):3721.
29. Ward JL, Harwood R, Smith C, et al. (2022). Risk factors for PICU admission and death among children and young people hospitalized with COVID-19 and PIMS-TS in England during the first pandemic year. Nature Med,28(1):193-200.
30. Iacobucci G (2020). Covid-19: Deprived areas have the highest death rates in England and Wales. BMJ,369:m1810.
31. Williamson EJ, Walker AJ, Bhaskaran K, et al. (2020). Factors associated with COVID-19-related death using OpenSAFELY. Nature,584(7821):430-6.
32. Vandentorren S, Smaili S, Chatignoux E, et al. (2022). The effect of social deprivation on the dynamic of SARS-CoV-2 infection in France: a population-based analysis. The Lancet Public Health,7(3):e240-e9.
33. Ossimetha A, Ossimetha A, Kosar CM, et al. (2021). Socioeconomic Disparities in Community Mobility Reduction and COVID-19 Growth. Mayo Clin Proc,96(1):78-85.
34. K CM, Oral E, Straif-Bourgeois S, et al. (2020). The effect of area deprivation on COVID-19 risk in Louisiana. PLoS ONE,15(12):e0243028.
35. Paremoer L, Nandi S, Serag H, et al. (2021). Covid-19 pandemic and the social determinants of health. BMJ,372:n129.
36. Dei V, Sebastian MS (2018). Is healthcare really equal for all? Assessing the horizontal and vertical equity in healthcare utilisation among older Ghanaians. Int J Equity Health,17(1):86.
37. Arasteh K (2021). Prevalence of Comorbidities and Risks Associated with COVID-19 Among Black and Hispanic Populations in New York City: an Examination of the 2018 New York City Community Health Survey. J Racial Ethn Health Disparities,8(4):863-9.
38. Clark A, Jit M, Warren-Gash C, et al. (2020). Global, regional, and national estimates of the population at increased risk of severe COVID-19 due to underlying health conditions in 2020: a modelling study. The Lancet Global Health,8(8):e1003-e17.
39. Ferdinand KC, Nasser SA (2020). African-American COVID-19 Mortality: A Sentinel Event. J Am Coll Cardiol,75(21):2746-8.
40. Abuelgasim E, Saw LJ, Shirke M, et al. (2020). COVID-19: Unique public health issues facing Black, Asian and minority ethnic communities. Curr Probl Cardiol,45(8):100621.
41. Kivimaki M, Kawachi I (2015). Work Stress as a Risk Factor for Cardiovascular Disease. Curr Cardiol Rep,17(9):630.
42. Sallis JF, Glanz K (2006). The role of built environments in physical activity, eating, and obesity in childhood. Future Child,16(1):89-108.
43. Treskova-Schwarzbach M, Haas L, Reda S, et al. (2021). Pre-existing health conditions and severe COVID-19 outcomes: an umbrella review approach and meta-analysis of global evidence. BMC Med,19(1):212.
44. Magesh S, John D, Li WT, et al. (2021). Disparities in COVID-19 Outcomes by Race, Ethnicity, and Socioeconomic Status: A Systematic-Review and Meta-analysis. JAMA Netw Open,4(11):e2134147.
45. Grasselli G, Greco M, Zanella A, et al. (2020). Risk Factors Associated With Mortality Among Patients With COVID-19 in Intensive Care Units in Lombardy, Italy. JAMA Intern Med,180(10):1345-55.
46. Rader B, Gertz A, Iuliano AD, et al. (2022). Use of At-Home COVID-19 Tests - United States, August 23, 2021-March 12, 2022. MMWR Morbidity and Mortality Weekly Report,71(13):489-94.
47. Shukla S, Fressin F, Un M, et al. (2022). Optimizing vaccine distribution via mobile clinics: a case study on COVID-19 vaccine distribution to long-term care facilities. Vaccine,40(5):734-41.
48. Sellner J, Jenkins TM, von Oertzen TJ, et al. (2021). Primary prevention of COVID-19: Advocacy for vaccination from a neurological perspective. Eur J Neurol,28(10):3226-9.
49. Hoven H, Dragano N, Angerer P, et al. (2022). Striving for Health Equity: The Importance of Social Determinants of Health and Ethical Considerations in Pandemic Preparedness Planning. Int J Public Health,67:1604542.
2. Mathur R, Rentsch CT, Morton CE, et al. (2021). 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(10286):1711-24.
3. Gomez CA, Kleinman DV, Pronk N, et al. (2021). Addressing Health Equity and Social Determinants of Health Through Healthy People 2030. J Public Health Manag Pract,27(Suppl 6):S249-S57.
4. Grosicki GJ, Bunsawat K, Jeong S, et al. (2022). Racial and ethnic disparities in cardiometabolic disease and COVID-19 outcomes in White, Black/African American, and Latinx populations: Social determinants of health. Prog Cardiovasc Dis, 71:11-19.
5. Ogedegbe G, Ravenell J, Adhikari S, et al. (2020). Assessment of Racial/Ethnic Disparities in Hospitalization and Mortality in Patients With COVID-19 in New York City. JAMA Netw Open,3(12):e2026881.
6. Mude W, Oguoma VM, Nyanhanda T, et al. (2021). Racial disparities in COVID-19 pandemic cases, hospitalisations, and deaths: A systematic review and meta-analysis. J Glob Health,11:05015.
7. Liaw W, Krist AH, Tong ST, et al. (2018). Living in "Cold Spot" Communities Is Associated with Poor Health and Health Quality. J Am Board Fam Med,31(3):342-50.
8. Kind AJ, Jencks S, Brock J, et al. (2014). Neighborhood socioeconomic disadvantage and 30-day rehospitalization: a retrospective cohort study. Ann Intern Med,161(11):765-74.
9. Salmond C, Crampton P, Sutton F (1998). NZDep91: A New Zealand index of deprivation. Aust N Z J Public Health,22(7):835-7.
10. Zhang Y, Ancker JS, Hall J, et al. (2020). Association Between Residential Neighborhood Social Conditions and Health Care Utilization and Costs. Med Care,58(7):586-93.
11. Bray I, Gibson A, White J (2020). Coronavirus disease 2019 mortality: a multivariate ecological analysis in relation to ethnicity, population density, obesity, deprivation and pollution. Public Health,185:261-3.
12. Gu T, Mack JA, Salvatore M, et al. (2020). Characteristics Associated With Racial/Ethnic Disparities in COVID-19 Outcomes in an Academic Health Care System. JAMA Netw Open,3(10):e2025197.
13. Patel AP, Paranjpe MD, Kathiresan NP, et al. (2020). Race, socioeconomic deprivation, and hospitalization for COVID-19 in English participants of a national biobank. Int J Equity Health,19(1):114.
14. Beaumont AL, Vignes D, Sterpu R, et al. (2022). Factors associated with hospital admission and adverse outcome for COVID-19: Role of social factors and medical care. Infect Dis Now, 52(3):130-137.
15. Escobar GJ, Adams AS, Liu VX, et al. (2021). Racial Disparities in COVID-19 Testing and Outcomes: Retrospective Cohort Study in an Integrated Health System. Ann Intern Med,174(6):786-93.
16. Moher D, Liberati A, Tetzlaff J, et al. (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ,339:b2535.
17. Higgins J (2011). Cochrane handbook for systematic reviews of interventions. Version 5.1. 0 (updated March 2011). The Cochrane Collaboration. https://handbook-5-1.cochrane.org/
18. DerSimonian R, Laird N (2015). Meta-analysis in clinical trials revisited. Contemp Clin Trials,45(Pt A):139-45.
19. Ingraham NE, Purcell LN, Karam BS, et al. (2020). Racial and Ethnic Disparities in Hospital Admissions from COVID-19: Determining the Impact of Neighborhood Deprivation and Primary Language. J Gen Intern Med,36(11):3462-70.
20. Jefferies S, French N, Gilkison C, et al. (2020). COVID-19 in New Zealand and the impact of the national response: a descriptive epidemiological study. The Lancet Public Health,5(11):e612-e23.
21. Lewis NM, Friedrichs M, Wagstaff S, et al. (2020). Disparities in COVID-19 Incidence, Hospitalizations, and Testing, by Area-Level Deprivation - Utah, March 3-July 9, 2020. MMWR Morbidity and Mortality Weekly Report,69(38):1369-73.
22. Cummins L, Ebyarimpa I, Cheetham N, et al. (2021). Factors associated with COVID-19 related hospitalisation, critical care admission and mortality using linked primary and secondary care data. Influenza Other Respir Viruses,15(5):577-88.
23. Saatci D, Ranger TA, Garriga C, et al. (2021). Association Between Race and COVID-19 Outcomes Among 2.6 Million Children in England. JAMA Pediatrics,175(9):928-38.
24. Zhang Y, Khullar D, Wang F, et al. (2021). Socioeconomic variation in characteristics, outcomes, and healthcare utilization of COVID-19 patients in New York City. PLoS ONE,16(7):e0255171.
25. Abda A, Del Giorgio F, Gauvin L, et al. (2022). Association between area-level material deprivation and incidence of hospitalization among children with SARS-CoV-2 in Montreal. Paediatr Child Health,27(Suppl 1):S27-S32.
26. Beaney T, Neves AL, Alboksmaty A, et al. (2022). Trends and associated factors for Covid-19 hospitalisation and fatality risk in 2.3 million adults in England. Nat Commun,13(1):2356.
27. Walls M, Priem JS, Mayfield CA, et al. (2022). Disparities in Level of Care and Outcomes Among Patients with COVID-19: Associations Between Race/Ethnicity, Social Determinants of Health and Virtual Hospitalization, Inpatient Hospitalization, Intensive Care, and Mortality. J Racial Ethn Health Disparities, 15:1-11.
28. Wan YI, Apea VJ, Dhairyawan R, et al. (2022). Ethnic disparities in hospitalisation and hospital-outcomes during the second wave of COVID-19 infection in east London. Scientific Reports, 12(1):3721.
29. Ward JL, Harwood R, Smith C, et al. (2022). Risk factors for PICU admission and death among children and young people hospitalized with COVID-19 and PIMS-TS in England during the first pandemic year. Nature Med,28(1):193-200.
30. Iacobucci G (2020). Covid-19: Deprived areas have the highest death rates in England and Wales. BMJ,369:m1810.
31. Williamson EJ, Walker AJ, Bhaskaran K, et al. (2020). Factors associated with COVID-19-related death using OpenSAFELY. Nature,584(7821):430-6.
32. Vandentorren S, Smaili S, Chatignoux E, et al. (2022). The effect of social deprivation on the dynamic of SARS-CoV-2 infection in France: a population-based analysis. The Lancet Public Health,7(3):e240-e9.
33. Ossimetha A, Ossimetha A, Kosar CM, et al. (2021). Socioeconomic Disparities in Community Mobility Reduction and COVID-19 Growth. Mayo Clin Proc,96(1):78-85.
34. K CM, Oral E, Straif-Bourgeois S, et al. (2020). The effect of area deprivation on COVID-19 risk in Louisiana. PLoS ONE,15(12):e0243028.
35. Paremoer L, Nandi S, Serag H, et al. (2021). Covid-19 pandemic and the social determinants of health. BMJ,372:n129.
36. Dei V, Sebastian MS (2018). Is healthcare really equal for all? Assessing the horizontal and vertical equity in healthcare utilisation among older Ghanaians. Int J Equity Health,17(1):86.
37. Arasteh K (2021). Prevalence of Comorbidities and Risks Associated with COVID-19 Among Black and Hispanic Populations in New York City: an Examination of the 2018 New York City Community Health Survey. J Racial Ethn Health Disparities,8(4):863-9.
38. Clark A, Jit M, Warren-Gash C, et al. (2020). Global, regional, and national estimates of the population at increased risk of severe COVID-19 due to underlying health conditions in 2020: a modelling study. The Lancet Global Health,8(8):e1003-e17.
39. Ferdinand KC, Nasser SA (2020). African-American COVID-19 Mortality: A Sentinel Event. J Am Coll Cardiol,75(21):2746-8.
40. Abuelgasim E, Saw LJ, Shirke M, et al. (2020). COVID-19: Unique public health issues facing Black, Asian and minority ethnic communities. Curr Probl Cardiol,45(8):100621.
41. Kivimaki M, Kawachi I (2015). Work Stress as a Risk Factor for Cardiovascular Disease. Curr Cardiol Rep,17(9):630.
42. Sallis JF, Glanz K (2006). The role of built environments in physical activity, eating, and obesity in childhood. Future Child,16(1):89-108.
43. Treskova-Schwarzbach M, Haas L, Reda S, et al. (2021). Pre-existing health conditions and severe COVID-19 outcomes: an umbrella review approach and meta-analysis of global evidence. BMC Med,19(1):212.
44. Magesh S, John D, Li WT, et al. (2021). Disparities in COVID-19 Outcomes by Race, Ethnicity, and Socioeconomic Status: A Systematic-Review and Meta-analysis. JAMA Netw Open,4(11):e2134147.
45. Grasselli G, Greco M, Zanella A, et al. (2020). Risk Factors Associated With Mortality Among Patients With COVID-19 in Intensive Care Units in Lombardy, Italy. JAMA Intern Med,180(10):1345-55.
46. Rader B, Gertz A, Iuliano AD, et al. (2022). Use of At-Home COVID-19 Tests - United States, August 23, 2021-March 12, 2022. MMWR Morbidity and Mortality Weekly Report,71(13):489-94.
47. Shukla S, Fressin F, Un M, et al. (2022). Optimizing vaccine distribution via mobile clinics: a case study on COVID-19 vaccine distribution to long-term care facilities. Vaccine,40(5):734-41.
48. Sellner J, Jenkins TM, von Oertzen TJ, et al. (2021). Primary prevention of COVID-19: Advocacy for vaccination from a neurological perspective. Eur J Neurol,28(10):3226-9.
49. Hoven H, Dragano N, Angerer P, et al. (2022). Striving for Health Equity: The Importance of Social Determinants of Health and Ethical Considerations in Pandemic Preparedness Planning. Int J Public Health,67:1604542.
| Files | ||
| Issue | Vol 51 No 11 (2022) | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v51i11.11163 | |
| Keywords | ||
| COVID-19 Socioeconomic status Social deprivation Healthcare utilization Meta-analysis | ||
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How to Cite
1.
Zhu Y-J, Tang K, Zhao F-J, Yu B-Y, Liu T-T, Zhang L-L. Impact of Social Deprivation on Hospitalization and Intensive Care Unit Admission among COVID-19 Patients: A Systematic Review and Meta-Analysis. Iran J Public Health. 2022;51(11):2458-2471.
