Kondo Karli K, Williams Beth E, Ayers Chelsea K, Kansagara Devan, Smith Mia, Advani Shailesh M, Young Sarah, Saha Somnath
Evidence Synthesis Program, Veterans Affairs Portland Health Care System, Portland, Oregon, USA.
Department of Research Integrity, Oregon Health & Science University, Portland, Oregon, USA.
Health Equity. 2022 Mar 24;6(1):254-269. doi: 10.1089/heq.2021.0049. eCollection 2022.
Previous pandemics may offer evidence on mediating factors that contributed to disparities in infection and poor outcomes, which could inform the effort to mitigate potential unequal outcomes during the current COVID-19 pandemic. This systematic review sought to examine those factors.
We searched MEDLINE, PsycINFO, and Cochrane to May 2020. We included studies examining health disparities in adult U.S. populations during infectious disease epidemics or pandemics. Two investigators screened abstracts and full text. We assessed study quality using the Newcastle/Ottawa Scale or the Critical Appraisal Skills Programme Checklist for Qualitative Studies.
Sixteen articles were included, of which 14 focused on health disparities during the 2009 H1N1 influenza pandemic. Studies showed that disparities during the H1N1 pandemic were more related to differential exposure to the virus than to susceptibility or access to care. Overall, pandemic-related disparities emanate primarily from inequalities in social conditions that place racial and ethnic minorities and low socioeconomic status populations at greater risk of exposure and infection, rather than individual-level factors such as health behaviors and comorbidities.
Policy- and systems-level interventions should acknowledge and address these social determinants of heightened risk, and future research should evaluate the effects of such interventions to avoid further exacerbation of health inequities during the current and future pandemics.
既往的大流行可能为导致感染差异和不良结局的中介因素提供证据，这可为减轻当前新冠疫情期间潜在的不平等结局的努力提供参考。本系统评价旨在研究这些因素。
我们检索了截至2020年5月的MEDLINE、PsycINFO和Cochrane数据库。我们纳入了研究美国成年人群在传染病流行或大流行期间健康差异的研究。两名研究人员筛选了摘要和全文。我们使用纽卡斯尔/渥太华量表或定性研究的批判性评价技能计划清单评估研究质量。
纳入了16篇文章，其中14篇关注2009年甲型H1N1流感大流行期间的健康差异。研究表明，甲型H1N1流感大流行期间的差异更多地与病毒暴露差异有关，而不是易感性或获得医疗服务的机会。总体而言，与大流行相关的差异主要源于社会条件的不平等，这些不平等使种族和少数民族以及社会经济地位低的人群面临更高的暴露和感染风险，而不是健康行为和合并症等个体层面的因素。
政策和系统层面的干预措施应承认并解决这些导致风险增加的社会决定因素，未来的研究应评估此类干预措施的效果，以避免在当前和未来的大流行期间进一步加剧健康不平等。
