Williams Beth E, Kondo Karli K, Ayers Chelsea K, Kansagara Devan, Young Sarah, Saha Somnath
Primary Care, VA Portland Health Care System, Portland, Oregon, USA.
Evidence Synthesis Program, VA Portland Health Care System, Portland, Oregon, USA.
Health Equity. 2021 Dec 27;5(1):856-871. doi: 10.1089/heq.2021.0016. eCollection 2021.
We sought to identify interventions that reduced disparities in health outcomes in infectious disease outbreaks or natural disasters in the United States to understand whether these interventions could reduce health disparities in the current COVID-19 pandemic. We searched MEDLINE and other databases to May 2020 to find studies that examined interventions to mitigate health inequalities in previous infectious disease pandemics or disasters. We assessed study quality using the Newcastle-Ottawa Scale and the Critical Appraisal Skills Program (CASP) Checklist for Qualitative Studies. We included 14 articles (12 studies) and 5 Centers for Disease Control (CDC) stakeholder meeting articles on pandemic influenza preparedness in marginalized populations. Studies called for intervention and engagement before pandemic or disaster onset. Several studies included interventions that could be adapted to COVID-19, including harnessing technology to reach disadvantaged populations, partnering with trusted community liaisons to deliver important messaging around disease mitigation, and using culturally specific communication methods and messages to best reach marginalized groups. To our knowledge this is the first systematic review to examine interventions to mitigate health inequities during an infectious disease pandemic. However, given that we identified very few disparities-focused infectious disease intervention studies, we also included studies from the disaster response literature, which may not be as generalizable to the current context of COVID-19. Overall, community outreach and tailored communication are essential in disease mitigation. More research is needed to evaluate systemic interventions that target the distal determinants of poor health outcomes among marginalized populations during pandemics and natural disasters.
我们试图确定在美国传染病爆发或自然灾害中能够减少健康结果差异的干预措施，以了解这些干预措施是否能减少当前新冠疫情中的健康差异。我们检索了截至2020年5月的MEDLINE及其他数据库，以查找研究此前传染病大流行或灾难中减轻健康不平等现象干预措施的研究。我们使用纽卡斯尔-渥太华量表和定性研究的批判性评估技能计划（CASP）清单来评估研究质量。我们纳入了14篇文章（12项研究）以及5篇关于边缘化人群大流行性流感防范的美国疾病控制与预防中心（CDC）利益相关者会议文章。研究呼吁在大流行或灾难发生前进行干预和参与。多项研究纳入了可适用于新冠疫情的干预措施，包括利用技术覆盖弱势群体、与值得信赖的社区联络人合作传递有关疾病缓解的重要信息，以及使用具有文化针对性的沟通方法和信息以最好地覆盖边缘化群体。据我们所知，这是第一项审查传染病大流行期间减轻健康不平等干预措施的系统评价。然而，鉴于我们发现极少有以差异为重点的传染病干预研究，我们还纳入了灾害应对文献中的研究，这些研究可能不太适用于当前的新冠疫情背景。总体而言，社区外展和针对性沟通在疾病缓解中至关重要。需要更多研究来评估针对大流行和自然灾害期间边缘化人群健康不良结果的远端决定因素的系统性干预措施。
