{"id":1850,"date":"2022-10-28T00:00:00","date_gmt":"2022-10-28T04:00:00","guid":{"rendered":"https:\/\/icesontario.wpengine.com\/journal-articles\/differential-patterns-by-area-level-social-determinants-of-health-in-covid-19-related-mortality-and-non-covid-19-mortality-a-population-based-study-of-11-8-million-people-in-ontario-canada\/"},"modified":"2023-12-21T11:20:28","modified_gmt":"2023-12-21T16:20:28","slug":"differential-patterns-by-area-level-social-determinants-of-health-in-covid-19-related-mortality-and-non-covid-19-mortality-a-population-based-study-of-11-8-million-people-in-ontario-canada","status":"publish","type":"journal_article","link":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/differential-patterns-by-area-level-social-determinants-of-health-in-covid-19-related-mortality-and-non-covid-19-mortality-a-population-based-study-of-11-8-million-people-in-ontario-canada\/","title":{"rendered":"Differential patterns by area-level social determinants of health in COVID-19 related mortality and non-COVID-19 mortality: a population-based study of 11.8 million people in Ontario, Canada"},"content":{"rendered":"

Background<\/strong> — Social determinants of health (SDOH) have been associated with COVID-19 outcomes. We examined differential patterns in COVID-19-related mortality by SDOH accounting for confounders and compared these patterns to those for non-COVID-19 mortality.<\/p>\n

Methods<\/strong> — Residents of Ontario, Canada aged ≥20 years were followed from March-01-2020 to March-02-2021. COVID-19-related death was defined as death within [-7,30] days of a positive COVID-19 test. Area-level SDOH from 2016 Census included: median household income; proportion with diploma or higher educational-attainment; proportion essential workers, racially-minoritised groups, recent immigrants, apartment buildings, and high-density housing; and average household size. We examined associations between SDOH and COVID-19-related mortality using cause-specific hazard models, treating non-COVID-19 mortality as competing risks, and vice-versa.<\/p>\n

Results<\/strong> — Of 11,810,255 individuals, we observed 3,880(0.03%) COVID-19-related deaths and 88,107(0.75%) non-COVID-19 deaths. After accounting for individual-level demographics, baseline health, and other area-level SDOH, the following area-level SDOH were associated with increased hazards of COVID-19-related death (hazard ratios[95% confidence intervals]: lower income (1.30[1.04-1.62]), lower educational-attainment (1.27[1.07-1.52]), higher proportions essential workers (1.28[1.05-1.57]), racially-minoritised groups (1.42[1.08-1.87]), apartment buildings (1.25[1.07-1.46]), and large vs. medium household size (1.30[1.12-1.50]). In comparison, areas with higher proportion racially-minoritised groups were associated with a lower hazard of non-COVID-19 mortality (0.88[0.84-0.92]).<\/p>\n

Conclusions<\/strong> — Area-level SDOH are associated with COVID-19-related mortality after accounting for demographic and clinical factors. COVID-19 has reversed patterns of lower non-COVID-19 mortality among racially-minoritised groups vs. their counterparts. Pandemic responses should include strategies (e.g., ‘hotspot’ and risk-group tailored vaccination) to address disproportionate risks and inequitable reach of, and access to, preventive interventions associated with SDOH.<\/p>\n","protected":false},"excerpt":{"rendered":"

Background — Social determinants of health (SDOH) have been associated with COVID-19 outcomes. We examined differential patterns in COVID-19-related mortality by SDOH accounting for confounders and compared these patterns to those for non-COVID-19 mortality. Methods — Residents of Ontario, Canada aged ≥20 years were followed from March-01-2020 to March-02-2021. COVID-19-related death was defined as death […]<\/p>\n","protected":false},"template":"","migration-helper-automated":[],"migration-manual":[],"topic":[],"migration-helper-qa-sample-set":[],"class_list":["post-1850","journal_article","type-journal_article","status-publish","hentry"],"acf":{"citation":"Wang L, Calzavara A, Baral S, Smylie J, Chan\u00a0 AK, Sander B, Austin PC, Kwong JC, Mishra S. Clin Infect Dis<\/em>. 2023; 76(6):1110-20. Epub 2022 Oct 28.","source_url":"https:\/\/academic.oup.com\/cid\/advance-article\/doi\/10.1093\/cid\/ciac850\/6776118","ices_scientist":[1149,1367,1362,1385,1320],"site":[6733],"research_program":[6745],"news_release":"","journal_article":"","atlas":"","research_report":"","infographic":"","video":"","downloads":null,"links":null,"sitecore_item_id":"18576CA9-BEAB-438D-AAE2-9B340485EB37","sitecore_item_name":"Differential-patterns-by-area-level-social-determinants-of-health-in-COVID-19-related-mortality","sitecore_field_values":"{\n \"Title\": \"Differential patterns by area-level social determinants of health in COVID-19 related mortality and non-COVID-19 mortality: a population-based study of 11.8 million people in Ontario, Canada\",\n \"Short title\": \"Differential patterns by area-level\",\n \"Citation\": \"

Wang L, Calzavara A, Baral S, Smylie J, Chan  AK, Sander B, Austin PC, Kwong JC, Mishra S. Clin Infect Dis<\/em>. 2022; Oct 28 [Epub ahead of print]. DOI: https:\/\/doi.org\/10.1093\/cid\/ciac850<\/a><\/p>\",\n \"Abstract\": \"

Background<\/strong> — Social determinants of health (SDOH) have been associated with COVID-19 outcomes. We examined differential patterns in COVID-19-related mortality by SDOH accounting for confounders and compared these patterns to those for non-COVID-19 mortality.<\/p>n

Methods<\/strong> — Residents of Ontario, Canada aged ≥20 years were followed from March-01-2020 to March-02-2021. COVID-19-related death was defined as death within [-7,30] days of a positive COVID-19 test. Area-level SDOH from 2016 Census included: median household income; proportion with diploma or higher educational-attainment; proportion essential workers, racially-minoritised groups, recent immigrants, apartment buildings, and high-density housing; and average household size. We examined associations between SDOH and COVID-19-related mortality using cause-specific hazard models, treating non-COVID-19 mortality as competing risks, and vice-versa.<\/p>n

Results<\/strong> — Of 11,810,255 individuals, we observed 3,880(0.03%) COVID-19-related deaths and 88,107(0.75%) non-COVID-19 deaths. After accounting for individual-level demographics, baseline health, and other area-level SDOH, the following area-level SDOH were associated with increased hazards of COVID-19-related death (hazard ratios[95% confidence intervals]: lower income (1.30[1.04-1.62]), lower educational-attainment (1.27[1.07-1.52]), higher proportions essential workers (1.28[1.05-1.57]), racially-minoritised groups (1.42[1.08-1.87]), apartment buildings (1.25[1.07-1.46]), and large vs. medium household size (1.30[1.12-1.50]). In comparison, areas with higher proportion racially-minoritised groups were associated with a lower hazard of non-COVID-19 mortality (0.88[0.84-0.92]).<\/p>n

Conclusions<\/strong> — Area-level SDOH are associated with COVID-19-related mortality after accounting for demographic and clinical factors. COVID-19 has reversed patterns of lower non-COVID-19 mortality among racially-minoritised groups vs. their counterparts. Pandemic responses should include strategies (e.g., ‘hotspot’ and risk-group tailored vaccination) to address disproportionate risks and inequitable reach of, and access to, preventive interventions associated with SDOH.<\/p>n

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