Health Services Research Group, Hospital del Mar Research Institute, Doctor Aiguader 88, office 144, Barcelona, 08003, Spain.
Preventive Medicine and Public Health Training Unit PSMar-UPF-ASPB (Parc de Salut Mar - Universitat Pompeu Fabra - Agència de Salut Pública de Barcelona), Barcelona, Spain.
Int J Equity Health. 2023 Jul 24;22(1):136. doi: 10.1186/s12939-023-01933-3.
Understanding the impact of the COVID-19 crisis on health involves conducting longitudinal studies to evaluate the inequalities that may have been exacerbated by the pandemic. The purpose of this study was to estimate differences in physical and mental health derived from the COVID-19 pandemic, beyond SARS-CoV-2 infection, in the Spanish general population according to the participants' level of education; and to assess the evolution of these differences from June 2020 (just after the lockdown) to nine months later (February-March 2021).
This is a longitudinal prospective study of a representative sample of non-institutionalized Spanish adults, through computer-assisted telephone interviews. Mobility, self-care, usual activities, pain/discomfort and anxiety/depression problems were measured with EQ-5D-5L. Prevalence ratio (PR) between high and low education levels and adjusted PR were estimated by Poisson regression models. Analyses were stratified by gender.
A total of 2,000 participants answered both surveys. Individuals with low level of education reported more health problems in both genders, and absolute inequalities remained quite constant (mobility and self-care problems) or decreased (pain/discomfort and anxiety/depression problems). The greatest relative inequalities were observed just after the lockdown, with age-adjusted PR ranging from 1.31 (95%CI 1.08-1.59) for women and 1.34 (95%CI 1.05-1.69) for men in pain/discomfort to 2.59 (95%CI 0.98-6.81) for women and 4.03 (95%CI 1.52-10.70) for men in self-care; aPR decreased after nine months for most dimensions.
Prevalence of health problems increased during the COVID-19 pandemic in all education groups, but the increase was higher in women and men with a high level of education, suggesting that its impact appeared later in this group. Further analysis on the role of governmental economic aid given to vulnerable people might shed light on this evolution.
了解 COVID-19 危机对健康的影响需要进行纵向研究，以评估大流行可能加剧的不平等现象。本研究的目的是根据参与者的受教育程度，估计西班牙普通人群中源自 COVID-19 大流行的身心健康差异，而不仅仅是 SARS-CoV-2 感染。此外，还评估了从 2020 年 6 月（封锁后不久）到 9 个月后（2021 年 2-3 月）这些差异的演变情况。
这是一项针对非住院西班牙成年人的代表性样本的纵向前瞻性研究，通过计算机辅助电话访谈进行。使用 EQ-5D-5L 测量流动性、自我护理、日常活动、疼痛/不适和焦虑/抑郁问题。通过泊松回归模型估计高教育水平和低教育水平之间的患病率比（PR）和调整后的 PR。分析按性别分层。
共有 2000 名参与者回答了两次调查。在两性中，受教育程度较低的个体报告了更多的健康问题，且绝对不平等程度相当稳定（流动性和自我护理问题）或降低（疼痛/不适和焦虑/抑郁问题）。最大的相对不平等现象出现在封锁后不久，调整年龄后的 PR 范围为女性 1.31（95%CI 1.08-1.59）和男性 1.34（95%CI 1.05-1.69）的疼痛/不适，以及女性 2.59（95%CI 0.98-6.81）和男性 4.03（95%CI 1.52-10.70）的自我护理；9 个月后，大多数维度的 aPR 都有所下降。
在 COVID-19 大流行期间，所有教育群体的健康问题患病率都有所增加，但高教育水平的女性和男性的增加幅度更高，这表明其影响在该群体中出现较晚。对政府向弱势群体提供的经济援助作用的进一步分析可能会揭示这种演变。
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