Influence of Social Determinants of Health on COVID-19 Infection in Socially Vulnerable Groups
Abstract
:1. Introduction
- Damaged houses and lack of infrastructure, equipment and public services.
- High rates of absenteeism and dropout.
- High rates of unemployment and lack of training.
- Significant hygienic-sanitary deficiencies.
2. Materials and Methods
2.1. Study Design
2.2. Study Population and Data Collection
2.3. Data Analysis
2.4. Ethical Considerations
3. Results
4. Discussion
4.1. Influence of Sociodemographic Variables
4.2. Influence of the Social Determinants of Health
4.3. Strengths and Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Kinross, P.; Suetens, C.; Gomes Dias, J.; Alexakis, L.; Wijermans, A.; Colzani, E.; Monnet, D.L.; ECDC Public Health Emergency Team. Rapidly increasing cumulative incidence of coronavirus disease (COVID-19) in the European Union/European Economic Area and the United Kingdom, 1 January to 15 March 2020. Eurosurveillance 2020, 25, 2000285. [Google Scholar] [CrossRef] [PubMed]
- Park, M.; Cook, A.R.; Lim, J.T.; Sun, Y.; Dickens, B.L. A Systematic Review of COVID-19 Epidemiology Based on Current Evidence. J. Clin. Med. 2020, 9, 967. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- WHO Coronavirus (COVID-19). Available online: https://covid19.who.int/ (accessed on 27 December 2021).
- Informe COVID-19 en Andalucía. Available online: https://www.juntadeandalucia.es/institutodeestadisticaycartografia/salud/COVID19.html (accessed on 27 December 2021).
- Ahmed, F.; Ahmed, N.; Pissarides, C.; Stiglitz, J. Why inequality could spread COVID-19. Lancet Public Health 2020, 5, e240. [Google Scholar] [CrossRef]
- Coronavirus Disease (COVID-19). Situation Reports. Available online: https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19---19-october-2021 (accessed on 19 October 2021).
- Wu, Z.; McGoogan, J.M. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA 2020, 323, 1239–1242. [Google Scholar] [CrossRef] [PubMed]
- Instituto de Salud Carlos III. Informe nº 24. Situación de COVID-19 en España a 21 de abril de 2020. Equipo COVID-19. RENAVE. CNE. CNM (ISCIII). Available online: https://www.isciii.es/QueHacemos/Servicios/VigilanciaSaludPublicaRENAVE/EnfermedadesTransmisibles/Paginas/InformesCOVID-19.aspx (accessed on 19 October 2021).
- Emami, A.; Javanmardi, F.; Pirbonyeh, N.; Akbari, A. Prevalence of Underlying Diseases in Hospitalized Patients with COVID-19: A Systematic Review and Meta-Analysis. Arch. Acad. Emerg. Med. 2020, 8, e35. [Google Scholar] [PubMed]
- Khalatbari-Soltani, S.; Cumming, R.C.; 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 2020, 74, 620–623. [Google Scholar] [CrossRef] [PubMed]
- Pareek, M.; Bangash, M.N.; Pareek, N.; Pan, D.; Sze, S.; Minhas, J.S.; Hanif, W.; Khunti, K. Ethnicity and COVID-19: An urgent public health research priority. Lancet 2020, 395, 1421–1422. [Google Scholar] [CrossRef]
- CDC. Coronavirus Disease 2019 (COVID-19) in Racial and Ethnic Minority Groups. Centers for Disease Control and Prevention. Available online: https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/race-ethnicity.html (accessed on 20 October 2021).
- Aldridge, R.W.; Lewer, D.; Katikireddi, S.V.; Mathur, R.; Pathak, N.; Burns, R.; Fragaszy, E.B.; Johnson, A.M.; Devakumar, D.; Abubakar, I.; et al. Black, Asian and Minority Ethnic groups in England are at increased risk of death from COVID-19: Indirect standardisation of NHS mortality data. Wellcome Open Res. 2020, 5, 88. [Google Scholar] [CrossRef]
- Price-Haywood, E.G.; Burton, J.; Fort, D.; Seoane, L. Hospitalization and Mortality among Black Patients and White Patients with COVID-19. N. Engl. J. Med. 2020, 382, 2534–2543. [Google Scholar] [CrossRef]
- Holtgrave, D.R.; Barranco, M.A.; Tesoriero, J.M.; Blog, D.S.; Rosenberg, E.S. Assessing racial and ethnic disparities using a COVID-19 outcomes continuum for New York State. Ann. Epidemiol. 2020, 48, 9–14. [Google Scholar] [CrossRef]
- Williamson, E.J.; Walker, A.J.; Bhaskaran, K.; Bacon, S.; Bates, C.; Morton, C.E.; Curtis, H.J.; Mehrkar, A.; Evans, D.; Inglesby, P.; et al. Factors associated with COVID-19-related death using OpenSAFELY. Nature 2020, 584, 430–436. [Google Scholar] [CrossRef] [PubMed]
- Jaqueti Aroca, J.; Molina Esteban, L.M.; García-Arata, I.; García-Martínez, J. COVID-19 en pacientes españoles e inmigrantes en un área sanitaria de Madrid [COVID-19 in Spanish and immigrant patients in a sanitary district of Madrid]. Rev. Española Quimioter. Publicación Of. Soc. Española Quimioter. 2020, 33, 289–291. [Google Scholar] [CrossRef] [PubMed]
- Webb Hooper, M.; Nápoles, A.M.; Pérez-Stable, E.J. COVID-19 and Racial/Ethnic Disparities. JAMA 2020, 323, 2466–2467. [Google Scholar] [CrossRef] [PubMed]
- Ji, Y.; Ma, Z.; Peppelenbosch, M.P.; Pan, Q. Potential association between COVID-19 mortality and health-care resource availability. Lancet Glob. Health 2020, 8, e480. [Google Scholar] [CrossRef] [Green Version]
- Martinez, D.A.; Hinson, J.S.; Klein, E.Y.; Irvin, N.A.; Saheed, M.; Page, K.R.; Levin, S.R. SARS-CoV-2 Positivity Rate for Latinos in the Baltimore-Washington, DC Region. JAMA 2020, 324, 392–395. [Google Scholar] [CrossRef]
- Chen, J.T.; Krieger, N. Revealing the Unequal Burden of COVID-19 by Income, Race/Ethnicity, and Household Crowding: US County Versus Zip Code Analyses. J. Public Health Manag. Pract. 2021, 27, S43–S56. [Google Scholar] [CrossRef]
- Baena-Díez, J.M.; Barroso, M.; Cordeiro-Coelho, S.I.; Díaz, J.L.; Grau, M. Impact of COVID-19 outbreak by income: Hitting hardest the most deprived. J. Public Health 2020, 42, 698–703. [Google Scholar] [CrossRef]
- Corburn, J.; Vlahov, D.; Mberu, B.; Riley, L.; Caiaffa, W.T.; Rashid, S.F.; Ko, A.; Patel, S.; Jukur, S.; Martínez-Herrera, E.; et al. Slum Health: Arresting COVID-19 and Improving Well-Being in Urban Informal Settlements. J. Urban Health 2020, 97, 348–357. [Google Scholar] [CrossRef] [Green Version]
- Gibson, L.; Rush, D. Novel Coronavirus in Cape Town Informal Settlements: Feasibility of Using Informal Dwelling Outlines to Identify High Risk Areas for COVID-19 Transmission From A Social Distancing Perspective. JMIR Public Health Surveill. 2020, 6, e18844. [Google Scholar] [CrossRef]
- Quaife, M.; van Zandvoort, K.; Gimma, A.; Shah, K.; McCreesh, N.; Prem, K.; Barasa, E.; Mwanga, D.; Kangwana, B.; Pinchoff, J.; et al. The impact of COVID-19 control measures on social contacts and transmission in Kenyan informal settlements. BMC Med. 2020, 18, 316. [Google Scholar] [CrossRef]
- Snyder, R.E.; Boone, C.E.; Cardoso, C.A.; Aguiar-Alves, F.; Neves, F.P.; Riley, L.W. Zika: A scourge in urban slums. PLoS Negl. Trop. Dis. 2017, 11, e0005287. [Google Scholar] [CrossRef] [Green Version]
- Snyder, R.E.; Marlow, M.A.; Riley, L.W. Ebola in urban slums: The elephant in the room. Lancet Glob. Health 2014, 2, e685. [Google Scholar] [CrossRef] [Green Version]
- Médicos del Mundo Andalucía. Informe Sobre la Exploratoria de Asentamientos Diseminados de Inmigrantes en el Ejido y Otras Zonas del Poniente Almeriense, Andalucía, 2021. Available online: https://www.medicosdelmundo.org/quienes-somos/sedes/medicos-del-mundo-andalucia. (accessed on 27 December 2021).
- Junta de Andalucía. Zonas Desfavorecidas de la Comunidad Autónoma de Andalucía, Andalucía, 2019. Available online: https://www.juntadeandalucia.es/export/drupaljda/Zonas_desfavorecidas_andalucia_2019.pdf (accessed on 28 December 2021).
- Ministerio de Sanidad. Equidad en Salud y COVID-19. Análisis y Propuestas Para Abordar la Vulnerabilidad Epidemiológica Vinculada a Las Desigualdades Sociales. Madrid, 2020. Available online: https://www.mscbs.gob.es/profesionales/saludPublica/ccayes/alertasActual/nCov/documentos/COVID19_Equidad_en_salud_y_COVID-19.pdf (accessed on 1 October 2021).
- Comisión Para Reducir Las Desigualdades Sociales En Salud En España. Propuesta de políticas e intervenciones para reducir las desigualdades sociales en salud en España [A proposal of policies and interventions to reduce social inequalities in health in Spain. Commission to Reduce Social Inequalities in Health in Spain]. Gac. Sanit. 2012, 26, 182–189. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Ruiz Cantero, M.T. Las estadísticas sanitarias y la invisibilidad por sexo y de género durante la epidemia de COVID-19 [Health statistics and invisibility by sex and gender during the COVID-19 epidemic]. Gac. Sanit. 2021, 35, 95–98. [Google Scholar] [CrossRef] [PubMed]
- Guijarro, C.; Pérez-Fernández, E.; González-Piñeiro, B.; Meléndez, V.; Goyanes, M.J.; Renilla, M.E.; Casas, M.L.; Sastre, I.; Velasco, M.; e Investigadores COVID Alcorcón, Investigadores COVID Alcorcón (colaboradores). Riesgo de COVID-19 en españoles y migrantes de distintas zonas del mundo residentes en España en la primera oleada de la enfermedad [Differential risk for COVID-19 in the first wave of the disease among Spaniards and migrants from different areas of the world living in Spain]. Rev. Clínica Española 2021, 221, 264–273. [Google Scholar] [CrossRef]
- Lee, C. “Race” and “ethnicity” in biomedical research: How do scientists construct and explain differences in health? Soc. Sci. Med. 2009, 68, 1183–1190. [Google Scholar] [CrossRef] [PubMed]
- Hayward, S.E.; Deal, A.; Cheng, C.; Crawshaw, A.; Orcutt, M.; Vandrevala, T.F.; Norredam, M.; Carballo, M.; Ciftci, Y.; Requena-Méndez, A.; et al. Clinical outcomes and risk factors for COVID-19 among migrant populations in high-income countries: A systematic review. J. Migr. Health 2021, 3, 100041. [Google Scholar] [CrossRef]
- Bambra, C.; Riordan, R.; Ford, J.; Matthews, F. The COVID-19 pandemic and health inequalities. J. Epidemiol. Community Health 2020, 74, 964–968. [Google Scholar] [CrossRef]
- Mehdipanah, R. Housing as a Determinant of COVID-19 Inequities. Am. J. Public Health 2020, 110, 1369–1370. [Google Scholar] [CrossRef]
- Koh, D. Migrant workers and COVID-19. Occup. Environ. Med. 2020, 77, 634–636. [Google Scholar] [CrossRef]
- Harlem, G. Descriptive analysis of social determinant factors in urban communities affected by COVID-19. J. Public Health 2020, 42, 466–469. [Google Scholar] [CrossRef] [PubMed]
- Shah, G.H.; Shankar, P.; Schwind, J.S.; Sittaramane, V. The Detrimental Impact of the COVID-19 Crisis on Health Equity and Social Determinants of Health. J. Public Health Manag. Pract. JPHMP 2020, 26, 317–319. [Google Scholar] [CrossRef] [PubMed]
- Patel, J.A.; Nielsen, F.; Badiani, A.A.; Assi, S.; Unadkat, V.A.; Patel, B.; Ravindrane, R.; Wardle, H. Poverty, inequality and COVID-19: The forgotten vulnerable. Public Health 2020, 183, 110–111. [Google Scholar] [CrossRef] [PubMed]
- Aguilar-Palacio, I.; Maldonado, L.; Malo, S.; Sánchez-Recio, R.; Marcos-Campos, I.; Magallón-Botaya, R.; Rabanaque, M.J. COVID-19 Inequalities: Individual and Area Socioeconomic Factors (Aragón, Spain). Int. J. Environ. Res. Public Health 2021, 18, 6607. [Google Scholar] [CrossRef] [PubMed]
- Marmot, M.; Allen, J. COVID-19: Exposing and amplifying inequalities. J. Epidemiol. Community Health 2020, 74, 681–682. [Google Scholar] [CrossRef] [PubMed]
- Birkmann, J. Measuring Vulnerability to Natural Hazards: Towards Disaster Resilient Societies; United Nations University Press: Nueva York, NY, USA, 2006. [Google Scholar]
- Birkmann, J. Danger Need not Spell Disaster but How Vulnerable Are We? Research Brief. 2005, 1, 1–8. [Google Scholar]
- Flaskerud, J.H.; Winslow, B.J. Conceptualizing vulnerable populations health-related research. Nurs. Res. 1998, 47, 69–78. [Google Scholar] [CrossRef]
- Copeland, D.A. Conceptualizing family members of violent mentally ill individuals as a vulnerable population. Issues Ment. Health Nurs. 2007, 28, 943–975. [Google Scholar] [CrossRef]
- Shi, L.; Stevens, G.D.; Faed, P.; Tsai, J. Rethinking vulnerable populations in the United States: An introduction to a general model of vulnerability. Harv. Health Policy Rev. 2008, 9, 43–48. [Google Scholar]
- Shi, L.; Stevens, G.D. Vulnerable Populations in the United States; Jossey-Bass Publishers: California, CA, USA, 2005. [Google Scholar]
Variables | COVID-19 Test Result | |||
---|---|---|---|---|
Positive (n = 84) | Negative (n = 662) | |||
M (SD) | M (SD) | p-Value | ||
Age (years) | 40.33 (13.81) | 40.08 (15.20) | 0.88 a | |
n (%) | n (%) | |||
Gender | Male | 57 (67.9) | 390 (58.9) | 0.11 b |
Female | 27 (32.1) | 272 (41.1) | ||
Nationality | Moroccan | 51 (60.7) | 364 (56.5) | <0.001 b |
Spanish | 11 (13.1) | 197 (30.6) | ||
Sub-Saharan | 22 (26.2) | 9 (12.9) | ||
Primary studies | Yes | 46 (54.8) | 379 (57.3) | 0.66 b |
No | 38 (45.2) | 283 (42.7) | ||
Tobacco | Yes | 10 (11.9) | 114 (17.2) | 0.21 b |
No | 74 (88.1) | 548 (82.8) | ||
Cannabinoids | Yes | 2 (2.4) | 33 (5) | 0.28 b |
No | 82 (97.6) | 629 (95) | ||
Alcohol | Yes | 10 (11.9) | 80 (12.1) | 0.96 b |
No | 74 (88.1) | 582 (87.9) | ||
Partner | Yes | 51 (60.7) | 364 (55) | 0.31 b |
No | 33 (39.3) | 298 (45) | ||
Children | Yes | 60 (71.4) | 412 (62.2) | 0.10 b |
No | 24 (28.6) | 250 (37.8) | ||
Regular administrative status | Yes | 62 (73.8) | 486 (73.4) | 0.93 b |
No | 22 (26.2) | 176 (26.6) |
Variables | COVID-19 Test Result | |||
---|---|---|---|---|
Positive (n = 84) | Negative (n = 662) | |||
M (SD) | M (SD) | p-Value | ||
n (%) | n (%) | |||
Type of housing | Shack | 3 (3.6) | 89 (13.4) | 0.95 |
Squatted house | 43 (51.2) | 304 (45.9) | ||
House | 38 (45.2) | 269 (40.6) | ||
Access to safe drinking water | Yes | 3 (3.6) | 126 (19) | <0.001 |
No | 81 (96.4) | 536 (81) | ||
Access to electricity | Yes | 77 (91.7) | 590 (89.1) | 0.47 |
No | 7 (8.3) | 72 (10.9) | ||
Overcrowding | Yes | 48 (57.1) | 334 (50.5) | 0.24 |
No | 36 (42.9) | 328 (49.5) | ||
Economic income | Low | 41 (49) | 406 (61.2) | 0.04 |
None | 43 (51) | 256 (38.8) | ||
Difficulty of access to the Public Health System | Yes | 12 (14.3) | 119 (18) | 0.40 |
No | 72 (85.7) | 543 (82) |
Parameters | OR | 95% C.I. | p-Value |
---|---|---|---|
No economic income | 2.26 | 1.41–3.62 | 0.001 |
No access to safe drinking water | 9.23 | 2.81–30.28 | 0.001 |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Morante-García, W.; Zapata-Boluda, R.M.; García-González, J.; Campuzano-Cuadrado, P.; Calvillo, C.; Alarcón-Rodríguez, R. Influence of Social Determinants of Health on COVID-19 Infection in Socially Vulnerable Groups. Int. J. Environ. Res. Public Health 2022, 19, 1294. https://doi.org/10.3390/ijerph19031294
Morante-García W, Zapata-Boluda RM, García-González J, Campuzano-Cuadrado P, Calvillo C, Alarcón-Rodríguez R. Influence of Social Determinants of Health on COVID-19 Infection in Socially Vulnerable Groups. International Journal of Environmental Research and Public Health. 2022; 19(3):1294. https://doi.org/10.3390/ijerph19031294
Chicago/Turabian StyleMorante-García, Wladimir, Rosa María Zapata-Boluda, Jessica García-González, Pedro Campuzano-Cuadrado, Cristobal Calvillo, and Raquel Alarcón-Rodríguez. 2022. "Influence of Social Determinants of Health on COVID-19 Infection in Socially Vulnerable Groups" International Journal of Environmental Research and Public Health 19, no. 3: 1294. https://doi.org/10.3390/ijerph19031294