The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
The George Institute for Global Health, School of Public Health, Imperial College London, London, UK.
J Epidemiol Community Health. 2021 Nov;75(11):1050-1055. doi: 10.1136/jech-2020-215810. Epub 2021 Apr 27.
To investigate sex differences in the effects of social deprivation on COVID-19 mortality and to place these effects in context with other diseases.
Prospective population-based study.
UK Biobank.
501 865 participants (54% women).
COVID-19 as the underlying cause of death.
Of 472 946 participants alive when COVID-19 was first apparent in the UK (taken as 1 February 2020), 217 (34% women) died from COVID-19 over the next 10 months, resulting in an incidence, per 100 000 person years, of 100.65 (95% CI 79.47 to 121.84) for women and 228.59 (95% CI 194.88 to 262.30) for men. Greater social deprivation, quantified using the Townsend Deprivation Score, was associated with greater risk of fatal COVD-19. Adjusted for age and ethnicity, HRs for women and men, comparing those in the most with the least deprived national fifths, were 3.66 (2.82 to 4.75) for women and 3.00 (2.46 to 3.66) for men. Adjustments for key baseline lifestyle factors attenuated these HRs to 2.20 (1.63 to 2.96) and 2.62 (2.12 to 3.24), respectively. There was evidence of a log-linear trend in the deprivation-fatal COVID-19 association, of similar magnitude to the equivalent trends for the associations between deprivation and fatal influenza or pneumonia and fatal cardiovascular disease. For all three causes of death, there was no evidence of a sex difference in the associations.
Higher social deprivation is a risk factor for death from COVID-19 on a continuous scale, with two to three times the risk in the most disadvantaged 20% compared with the least. Similarities between the social gradients in COVID-19, influenza/pneumonia and cardiovascular disease mortality, the lack of sex differences in these effects, and the partial mediation of lifestyle factors suggest that better social policies are crucial to alleviate the general medical burden, including from the current, and potential future, viral pandemics.
探讨社会剥夺对 COVID-19 死亡率的影响在性别上的差异，并将这些影响与其他疾病进行对比。
前瞻性基于人群的研究。
英国生物银行。
501865 名参与者（54%为女性）。
COVID-19 为根本死因。
在英国首次出现 COVID-19 时仍存活的 472946 名参与者中，在接下来的 10 个月内有 217 人（34%为女性）死于 COVID-19，导致每 10 万人年的发病率为 100.65（95%CI79.47 至 121.84）为女性，228.59（95%CI194.88 至 262.30）为男性。使用 Townsend 剥夺评分量化的更高社会剥夺程度与致命 COVID-19 的风险增加相关。在调整年龄和种族后，与最不受剥夺的五分之一相比，女性和男性的 HRs 分别为 3.66（2.82 至 4.75）和 3.00（2.46 至 3.66）。对关键基线生活方式因素的调整将这些 HR 分别降低至 2.20（1.63 至 2.96）和 2.62（2.12 至 3.24）。在社会剥夺与致命 COVID-19 之间的关联中存在对数线性趋势，其与流感或肺炎和心血管疾病致死之间的关联相当。对于所有三种死亡原因，在关联中没有证据表明性别差异。
较高的社会剥夺是 COVID-19 死亡的一个风险因素，在最不利的 20%人群中，风险比最不受影响的 20%人群高两到三倍。在 COVID-19、流感/肺炎和心血管疾病死亡率的社会梯度之间存在相似性，这些影响中没有性别差异，以及生活方式因素的部分中介作用表明，更好的社会政策对于缓解包括当前和潜在未来的病毒大流行在内的一般医疗负担至关重要。
