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Waves of inequality: income differences in intensive care due to Covid-19 in Sweden
BACKGROUND: Socioeconomically vulnerable groups were overall more likely to develop severe Covid-19, but specific conditions in terms of preparedness, knowledge and the properties of the virus itself changed during the course of the pandemic. Inequalities in Covid-19 may therefore shift over time. T...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10393505/ https://www.ncbi.nlm.nih.gov/pubmed/37322545 http://dx.doi.org/10.1093/eurpub/ckad094 |
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author | Gauffin, Karl Östergren, Olof Cederström, Agneta |
author_facet | Gauffin, Karl Östergren, Olof Cederström, Agneta |
author_sort | Gauffin, Karl |
collection | PubMed |
description | BACKGROUND: Socioeconomically vulnerable groups were overall more likely to develop severe Covid-19, but specific conditions in terms of preparedness, knowledge and the properties of the virus itself changed during the course of the pandemic. Inequalities in Covid-19 may therefore shift over time. This study examines the relationship between income and intensive care (ICU) episodes due to Covid-19 in Sweden during three distinct waves. METHODS: This study uses Swedish register data on the total adult population and estimates the relative risk (RR) of ICU episodes due to Covid-19 by income quartile for each month between March 2020 and May 2022, and for each wave, using Poisson regression analyses. RESULTS: The first wave had modest income-related inequalities, while the second wave had a clear income gradient, with the lowest income quartile having an increased risk compared to the high-income group [RR: 1.55 (1.36–1.77)]. In the third wave, the overall need for ICU decreased, but RRs increased, particularly in the lowest income quartile [RR: 3.72 (3.50–3.96)]. Inequalities in the third wave were partly explained by differential vaccination coverage by income quartile, although substantial inequalities remained after adjustment for vaccination status [RR: 2.39 (2.20–2.59)]. CONCLUSIONS: The study highlights the importance of considering the changing mechanisms that connect income and health during a novel pandemic. The finding that health inequalities increased as the aetiology of Covid-19 became better understood could be interpreted through the lens of adapted fundamental cause theory. |
format | Online Article Text |
id | pubmed-10393505 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-103935052023-08-02 Waves of inequality: income differences in intensive care due to Covid-19 in Sweden Gauffin, Karl Östergren, Olof Cederström, Agneta Eur J Public Health Social Determinants BACKGROUND: Socioeconomically vulnerable groups were overall more likely to develop severe Covid-19, but specific conditions in terms of preparedness, knowledge and the properties of the virus itself changed during the course of the pandemic. Inequalities in Covid-19 may therefore shift over time. This study examines the relationship between income and intensive care (ICU) episodes due to Covid-19 in Sweden during three distinct waves. METHODS: This study uses Swedish register data on the total adult population and estimates the relative risk (RR) of ICU episodes due to Covid-19 by income quartile for each month between March 2020 and May 2022, and for each wave, using Poisson regression analyses. RESULTS: The first wave had modest income-related inequalities, while the second wave had a clear income gradient, with the lowest income quartile having an increased risk compared to the high-income group [RR: 1.55 (1.36–1.77)]. In the third wave, the overall need for ICU decreased, but RRs increased, particularly in the lowest income quartile [RR: 3.72 (3.50–3.96)]. Inequalities in the third wave were partly explained by differential vaccination coverage by income quartile, although substantial inequalities remained after adjustment for vaccination status [RR: 2.39 (2.20–2.59)]. CONCLUSIONS: The study highlights the importance of considering the changing mechanisms that connect income and health during a novel pandemic. The finding that health inequalities increased as the aetiology of Covid-19 became better understood could be interpreted through the lens of adapted fundamental cause theory. Oxford University Press 2023-06-15 /pmc/articles/PMC10393505/ /pubmed/37322545 http://dx.doi.org/10.1093/eurpub/ckad094 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of the European Public Health Association. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Social Determinants Gauffin, Karl Östergren, Olof Cederström, Agneta Waves of inequality: income differences in intensive care due to Covid-19 in Sweden |
title | Waves of inequality: income differences in intensive care due to Covid-19 in Sweden |
title_full | Waves of inequality: income differences in intensive care due to Covid-19 in Sweden |
title_fullStr | Waves of inequality: income differences in intensive care due to Covid-19 in Sweden |
title_full_unstemmed | Waves of inequality: income differences in intensive care due to Covid-19 in Sweden |
title_short | Waves of inequality: income differences in intensive care due to Covid-19 in Sweden |
title_sort | waves of inequality: income differences in intensive care due to covid-19 in sweden |
topic | Social Determinants |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10393505/ https://www.ncbi.nlm.nih.gov/pubmed/37322545 http://dx.doi.org/10.1093/eurpub/ckad094 |
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