Socioeconomic position and the COVID-19 care cascade from testing to mortality in Switzerland: a population-based analysis

作者：Julien Riou, Radoslaw Panczak, Christian L. Althaus, Christoph Junker, Damir Perisa, Katrin Schneider, Nicola G. Criscuolo, Nicola Low, Matthias Egger · 发表于：The Lancet Public Health · 年份：2021 · DOI：10.1016/s2468-2667(21)00160-2 · 被引用次数：148 · 研究领域：COVID-19 epidemiological studies、COVID-19 and healthcare impacts、COVID-19 Clinical Research Studies

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...