Institut de Recherche Interdisciplinaire sur les enjeux Sociaux - Sciences sociales, politique, santé, IRIS (UMR 8156 CNRS - EHESS - U997 INSERM), Aubervilliers, France
INED, Paris, France.
BMJ Open. 2021 Nov 11;11(11):e052888. doi: 10.1136/bmjopen-2021-052888.
Although social inequalities in COVID-19 mortality by race, gender and socioeconomic status are well documented, less is known about social disparities in infection rates and their shift over time. We aim to study the evolution of social disparities in infection at the early stage of the epidemic in France with regard to the policies implemented.
Random population-based prospective cohort.
From May to June 2020 in France.
Adults included in the Epidémiologie et Conditions de Vie cohort (n=77 588).
Self-reported anosmia and/or ageusia in three categories: no symptom, during the first epidemic peak (in March 2020) or thereafter (during lockdown).
In all, 2052 participants (1.53%) reported anosmia/ageusia. The social distribution of exposure factors (density of place of residence, overcrowded housing and working outside the home) was described. Multinomial regressions were used to identify changes in social variables (gender, class and race) associated with symptoms of anosmia/ageusia. Women were more likely to report symptoms during the peak and after. Racialised minorities accumulated more exposure risk factors than the mainstream population and were at higher risk of anosmia/ageusia during the peak and after. By contrast, senior executive professionals were the least exposed to the virus with the lower rate of working outside the home during lockdown. They were more affected than lower social classes at the peak of the epidemic, but this effect disappeared after the peak.
The shift in the social profile of the epidemic was related to a shift in exposure factors under the implementation of a stringent stay-at-home order. Our study shows the importance to consider in a dynamic way the gender, socioeconomic and race direct and indirect effects of the COVID-19 pandemic, notably to implement policies that do not widen health inequalities.
尽管种族、性别和社会经济地位方面的 COVID-19 死亡率存在社会不平等现象已得到充分记录，但人们对感染率的社会差异及其随时间的变化知之甚少。我们旨在研究与所实施政策相关的法国疫情早期感染的社会差异演变。
随机人群前瞻性队列研究。
2020 年 5 月至 6 月期间在法国。
纳入 Epidémiologie et Conditions de Vie 队列的成年人（n=77588）。
分为无症状、2020 年 3 月疫情高峰期（第一波）期间和之后（封锁期间）三种情况报告的嗅觉丧失和/或味觉丧失。
共有 2052 名参与者（1.53%）报告嗅觉丧失/味觉丧失。描述了接触因素（居住密度、过度拥挤的住房和在家外工作）的社会分布。使用多项回归分析确定与嗅觉丧失/味觉丧失相关的社会变量（性别、阶层和种族）的变化。女性在高峰期和之后更有可能报告症状。种族化少数群体比主流人群积累了更多的暴露危险因素，在高峰期和之后更有可能出现嗅觉丧失/味觉丧失。相比之下，高级管理人员在封锁期间在家外工作的比例最低，接触病毒的风险最低。在疫情高峰期，他们比社会较低阶层受影响更大，但这种影响在高峰期后消失。
在实施严格的居家令的情况下，接触因素的变化导致了疫情社会特征的转变。我们的研究表明，重要的是要以动态的方式考虑 COVID-19 大流行的性别、社会经济和种族的直接和间接影响，特别是要实施不会扩大健康不平等的政策。
