Albani Viviana, Welsh Claire E, Brown Heather, Matthews Fiona E, Bambra Clare
Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, UK.
Department of Health Research, Faculty of Health and Medicine, Lancaster University, UK.
Soc Sci Med. 2022 Oct;311:115319. doi: 10.1016/j.socscimed.2022.115319. Epub 2022 Sep 5.
One of the most consistent and worrying features of the COVID-19 pandemic globally has been the disproportionate burden of the epidemic in the most deprived areas. Most of the literature so far though has focused on estimating the extent of these inequalities. There has been much less attention paid to exploring the main pathways underpinning them. In this study, we employ the syndemic pandemic theoretical framework and apply novel decomposition methods to investigate the proportion of the COVID-19 mortality gap by area-level deprivation in England during the first wave of the pandemic (January to July 2020) was accounted for by pre-existing inequalities in the compositional and contextual characteristics of place. We use a decomposition approach to explicitly quantify the independent contribution of four inequalities pathways (vulnerability, susceptibility, exposure and transmission) in explaining the more severe COVID-19 outcomes in the most deprived local authorities compared to the rest. We find that inequalities in transmission (73%) and in vulnerability (49%) factors explained the highest proportion of mortality by deprivation. Our results suggest that public health agencies need to develop short- and long-term strategies to alleviate these underlying inequalities in order to alleviate the more severe impacts on the most vulnerable communities.
全球新冠疫情最持续且令人担忧的特征之一，是疫情在最贫困地区造成的负担过重。然而，迄今为止的大多数文献都集中在估计这些不平等的程度上。对于探索造成这些不平等的主要途径，关注则少得多。在本研究中，我们采用共病流行理论框架并应用新颖的分解方法，来调查在疫情第一波期间（2020年1月至7月），英格兰地区层面贫困导致的新冠死亡率差距中，有多大比例是由地方在构成和背景特征方面预先存在的不平等造成的。我们使用一种分解方法，明确量化四条不平等途径（脆弱性、易感性、暴露和传播）在解释最贫困地方当局与其他地方当局相比更严重的新冠疫情结果方面的独立贡献。我们发现，传播方面的不平等（73%）和脆弱性方面的不平等（49%）因素在因贫困导致的死亡率中所占比例最高。我们的结果表明，公共卫生机构需要制定短期和长期战略，以缓解这些潜在的不平等，从而减轻对最脆弱社区的更严重影响。
