Mehdizadeh Parisa, Baygi Valiollah, Teymourzadeh Ehsan
Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.
Department of Geriatric Medicine, Ziaeian Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Iran J Public Health. 2023 Jun;52(6):1269-1277. doi: 10.18502/ijph.v52i6.12993.
One approach to reducing the burden of diseases can be to identify socioeconomically vulnerable groups. We aimed to estimate the socioeconomic inequality of in-hospital deaths using relative and absolute indices of socioeconomic inequality.
In this retrospective cohort study on Covid-19 patients; age, gender, marital status, education level, date of admission, diagnostic method, and final condition were measured. Socioeconomic inequality in inhospital death was assessed using three approaches. We used the relative index of inequality (RII) to measure relative inequality. We used two approaches to evaluate absolute inequality: the slope index of inequality (SII) and the concentration index (ci).
Overall, 587 patients' data were collected and 42 (7.2%) of these patients died in the hospital. There were statistically significant differences between the case-fatality rates of different levels of education (<0.001). In addition, all the inequality indices showed that the distribution of COVID-19-related deaths was higher among the lower education levels. Accordingly, after controlling the effect of age, gender, and comorbidities the RII indicated that the case fatality rate in the lowest education level was 9.42 (95% CI: 2.23 to 39.01, <0.001) times compared to the case fatality rate in the highest level of education.
The results of all three approaches indicate considerable education inequality in CFR in favor of groups of high education levels. These results can improve the prioritization and impact of public health interventions, including prevention and diagnosis of Covid-19 in favor of vulnerable groups.
减轻疾病负担的一种方法是识别社会经济弱势群体。我们旨在使用社会经济不平等的相对和绝对指标来估计住院死亡的社会经济不平等情况。
在这项关于新冠肺炎患者的回顾性队列研究中，对年龄、性别、婚姻状况、教育水平、入院日期、诊断方法和最终状况进行了测量。采用三种方法评估住院死亡的社会经济不平等。我们使用不平等相对指数（RII）来衡量相对不平等。我们使用两种方法评估绝对不平等：不平等斜率指数（SII）和集中指数（CI）。
总体而言，收集了587例患者的数据，其中42例（7.2%）在医院死亡。不同教育水平的病死率之间存在统计学显著差异（<0.001）。此外，所有不平等指数均显示，与新冠肺炎相关的死亡在低教育水平人群中的分布更高。因此，在控制年龄、性别和合并症的影响后，RII表明，最低教育水平的病死率是最高教育水平病死率的9.42倍（95%CI：2.23至39.01，<0.001）。
所有三种方法的结果均表明，病死率在教育方面存在相当大的不平等，有利于高教育水平群体。这些结果可以改善公共卫生干预措施的优先排序和影响，包括有利于弱势群体的新冠肺炎预防和诊断。
