The poorest people least likely to be tested for SARS-CoV-2, more likely to be hospitalized, enter the ICU and die: study

A new Swiss study presented at this year’s European Congress of Clinical Microbiology and Infectious Diseases (ECCMID), held online this year, shows that people living in poorer neighborhoods are less likely to take COVID-19 tests. but they are more likely to give positive. hospitalized or die, compared to those in richer areas. The study is by Professor Matthias Egger and Dr. Julien Riou, of the Institute of Social and Preventive Medicine, Bern, Switzerland.

For the study, the authors analyzed the surveillance data reported to the Swiss Federal Public Health Office from March 1, 2020 to April 16, 2021. They assigned a rating to each residence. included in the study, by neighborhood socio-economic position index (Swiss-SEP). The index describes 1.27 million small neighborhoods of approximately 50 households each based on rent per m², education and employment of heads of households, and overcrowding, ranking each residence as 1 (the most poor) to 10 (the richest). Models were adjusted for sex, age, canton (administrative area), and epidemic wave (before or after June 8, 2020).

Analyzes were based on 4,129,636 tests, 609,782 positive tests, 26,143 hospitalizations, 2,432 ICU admissions, 9383 deaths, and 8,21,406 residents. Comparing the highest with the lowest group of Swiss-SEP and using the general population As a denominator, richer SEP neighborhoods were 18% more likely to test for SARS-CoV-2 than those in poorer countries. And, compared to the poorest neighborhoods, those in the richest neighborhoods were 25% less likely to test positive, 32% less likely to be hospitalized, 46% less likely to be admitted to the ICU, and 14% less likely to to die.

The authors also found that these associations between neighborhood SEP and outcomes were stronger in younger age groups, probably because frail people, who are over-represented in socioeconomically disadvantaged groups, die at younger ages; therefore, older survivors are a select group of healthier people.

The authors say: “In this study of the entire population on the COVID-19 epidemic in Switzerland in 2020-21, we found that people living in richer areas were more likely to be tested for SARS-CoV -2, but less likely to test positive and be admitted to hospital or ICU and less likely to die compared to those in poorer areas. “

They explain: “The higher incidence of SARS-CoV-2 infections, combined with a higher prevalence of comorbidities in poorer neighborhoods compared to richer neighborhoods will likely have contributed to worse outcomes, including increased risk of hospitalization and death. By June 2021, vaccination coverage had increased considerably, as more than 40% of the Swiss population had received at least one dose of SARS-CoV-2 vaccine and the Government was gradually facilitating preventive measures. continue to monitor SARS-CoV-2 testing, access and adoption of COVID-19 vaccination and COVID-19 results Governments and health systems should address this pandemic of inequality by taking steps to reduce inequalities in health in its response to the SARS-CoV-2 pandemic “.

The authors also note that this study illustrates the “reverse care law” in the unique framework of a pandemic in Switzerland, one of the richest countries in the world. The reverse care law was enacted 50 years ago and states that disadvantaged populations need more health care than disadvantaged populations, but in reality receive less.

Provided by the European Society of Clinical Microbiology and Infectious Diseases