Institute of Health Informatics, University College London, London, United Kingdom; Department of Cardiology, Barts Health NHS Trust, London, United Kingdom.
Can J Cardiol. 2024 Jun;40(6):1123-1134. doi: 10.1016/j.cjca.2024.02.017. Epub 2024 Feb 28.
Long COVID has been defined by the World Health Organisation as "continuation or development of new symptoms 3 months after the initial SARS-CoV-2 infection, with these symptoms lasting for at least 2 months with no other explanation." Cardiovascular disease is implicated as a risk factor, concomitant condition, and consequence of long COVID. As well as heterogeneity in definition, presentation, and likely underlying pathophysiology of long COVID, disparities by social determinants of health, extensively studied and described in cardiovascular disease, have been observed in 3 ways. First, underlying long-term conditions, such as cardiovascular disease and its risk factors, are associated with incidence and severity of long COVID, and previously described socioeconomic disparities in these factors are important in exacerbating disparities in long COVID. Second, socioeconomic disparities in management of COVID-19 may themselves lead to distal disparities in long COVID. Third, there are socioeconomic disparities in the way that long COVID is diagnosed, managed, and prevented. Together, factors such as age, sex, deprivation, and ethnicity have far-reaching implications in this new postviral syndrome across its management spectrum. There are similarities and differences compared with disparities for cardiovascular disease. Some of these disparities are in fact, inequalities, that is, rather than simply observed variations, they represent injustices with costs to individuals, communities, and economies. This review of current literature considers opportunities to prevent or at least attenuate these socioeconomic disparities in long COVID and cardiovascular disease, with special challenges for research, clinical practice, public health, and policy in a new disease which is evolving.
长新冠已被世界卫生组织定义为“初次感染 SARS-CoV-2 后 3 个月出现持续或新的症状，这些症状至少持续 2 个月且没有其他解释”。心血管疾病被认为是长新冠的风险因素、伴随疾病和后果。除了长新冠在定义、表现和潜在病理生理学方面存在异质性外，在心血管疾病中广泛研究和描述的健康社会决定因素导致的差异以 3 种方式被观察到。首先，心血管疾病及其危险因素等潜在的长期疾病与长新冠的发病和严重程度相关，以前描述的这些因素的社会经济差异在加剧长新冠的差异方面非常重要。其次，COVID-19 管理方面的社会经济差异本身可能导致长新冠的远端差异。第三，长新冠的诊断、管理和预防方面存在社会经济差异。总之，年龄、性别、贫困和种族等因素在这种新的病毒性综合征的整个管理范围内具有深远的影响。与心血管疾病的差异既有相似之处，也有不同之处。其中一些差异实际上是不平等现象，也就是说，这些差异不仅是观察到的差异，而且是代表对个人、社区和经济造成代价的不公正现象。这篇对现有文献的综述考虑了预防或至少减轻长新冠和心血管疾病中的这些社会经济差异的机会，对于在一种不断演变的新疾病的研究、临床实践、公共卫生和政策方面存在特殊挑战。
