Aung Myo Nyein, Koyanagi Yuka, Yuasa Motoyuki
Juntendo Advanced Research Institute for Health Science, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
Global Health Service, Faculty of International Liberal Arts, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
J Egypt Public Health Assoc. 2021 Feb 17;96(1):3. doi: 10.1186/s42506-021-00067-0.
BACKGROUND: The new coronavirus outbreak originated in Wuhan, China, started in January 2020 is escalating as a pandemic across the globe in March 2020. It causes unprecedented morbidity and shocked health systems and the supply chains in new epicenters such as Italy, Spain, and the USA, claiming thousands of lives. Meanwhile, the pandemic is reaching swiftly and silently to low-income countries where international media cover less. How likely health outcomes among the countries with different economies may differ during the pandemic has not been reported yet. Methodologically, we conducted an analysis of COVID-19 deaths comparing case fatality rate (CFR) among countries with different income categories, applying COVID-19 global data from the European Centre for Disease Control including 199 countries' data as of 31 March 2020, in the early phase of the pandemic. We categorized countries into high-income countries (HIC), upper-middle-income countries (UMIC), lower-middle-income countries (LMIC), and low-income countries (LIC) according to World Bank classification by income as of 2020. FINDING: Statistically, countries in different income groups are significantly different in terms of new cases identified in the last 2 weeks and the case fatality rate (MANOVA, P value < 0.001). New tests and detected case numbers shot up in HICs where CFR shot up in LMICs and LICs. The results of this analysis pointed out an important gap among countries with different economic status during the ongoing pandemic. CONCLUSION: In the HIC, contact tracing, testing capacity, and outbreak response, as well as clinical services, are strong. In the LICs, there is a low capacity of outbreak response which is reflected by the significantly lower number of diagnostic tests. Consequently, the reported number of COVID-19 cases in LICs may not reflect the actual burden of the pandemic. Without effective prevention, the pandemic can readily break into the weak health system and over-burden the hospitals and clinical services in poor countries. This finding is showing health inequality between the rich and the poor being amplified by the COVID-19 pandemic. Addressing such a gap through the local governance and integrated global responses will not only prevent unprecedented deaths, but also preserve the momentum towards Sustainable Development Goals (SDGs).
背景：新型冠状病毒疫情于2020年1月在中国武汉爆发，并于2020年3月在全球范围内升级为大流行。它造成了前所未有的发病率，冲击了意大利、西班牙和美国等新疫情中心的卫生系统和供应链，夺走了数千人的生命。与此同时，这场大流行正在迅速而悄然地蔓延到国际媒体报道较少的低收入国家。在大流行期间，不同经济体国家的健康结果可能存在差异的可能性尚未得到报道。在方法上，我们对新冠病毒死亡病例进行了分析，比较了不同收入类别的国家之间的病死率（CFR），采用了欧洲疾病控制中心的新冠病毒全球数据，包括截至2020年3月31日的199个国家的数据，这是在大流行的早期阶段。我们根据世界银行2020年的收入分类将国家分为高收入国家（HIC）、中高收入国家（UMIC）、中低收入国家（LMIC）和低收入国家（LIC）。 研究结果：从统计学角度来看，不同收入组的国家在过去两周内确诊的新病例数和病死率方面存在显著差异（多变量方差分析，P值<0.001）。高收入国家的新检测和确诊病例数激增，而中低收入国家和低收入国家的病死率则大幅上升。这一分析结果指出了在当前大流行期间不同经济状况国家之间的一个重要差距。 结论：在高收入国家，接触者追踪、检测能力、疫情应对以及临床服务都很强。在低收入国家，疫情应对能力较低，这体现在诊断检测数量明显较少上。因此，低收入国家报告的新冠病毒病例数可能无法反映大流行的实际负担。如果没有有效的预防措施，大流行很容易突破薄弱的卫生系统，使贫穷国家的医院和临床服务不堪重负。这一发现表明，新冠病毒大流行加剧了贫富之间的健康不平等。通过地方治理和全球综合应对来弥合这一差距，不仅可以防止前所未有的死亡，还能保持实现可持续发展目标（SDG）的势头。
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