Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands.
Center for Public Health, Healthcare & Society, National Institute for Public Health and the Environment, P.O. Box 1, 3720 BA, Bilthoven, The Netherlands.
Eur J Health Econ. 2024 Dec;25(9):1581-1594. doi: 10.1007/s10198-024-01680-4. Epub 2024 Mar 18.
The COVID-19 pandemic exacerbated healthcare needs and caused excess mortality, especially among lower socioeconomic groups. This study describes the emergence of socioeconomic differences along the COVID-19 pathway of testing, healthcare use and mortality in the Netherlands.
This retrospective observational Dutch population-based study combined individual-level registry data from June 2020 to December 2020 on personal socioeconomic characteristics, COVID-19 administered tests, test results, general practitioner (GP) consultations, hospital admissions, Intensive Care Unit (ICU) admissions and mortality. For each outcome measure, relative differences between income groups were estimated using log-link binomial regression models. Furthermore, regression models explained socioeconomic differences in COVID-19 mortality by differences in ICU/hospital admissions, test administration and test results.
Among the Dutch population, the lowest income group had a lower test probability (RR = 0.61) and lower risk of testing positive (RR = 0.77) compared to the highest income group. However, among individuals with at least one administered COVID-19 test, the lowest income group had a higher risk of testing positive (RR = 1.40). The likelihood of hospital admissions and ICU admissions were higher for low income groups (RR = 2.11 and RR = 2.46, respectively). The lowest income group had an almost four times higher risk of dying from COVID-19 (RR = 3.85), which could partly be explained by a higher risk of hospitalization and ICU admission, rather than differences in test administration or result.
Our findings indicated that socioeconomic differences became more pronounced at each step of the care pathway, culminating to a large gap in mortality. This underlines the need for enhancing social security and well-being policies and incorporation of health equity in pandemic preparedness plans.
COVID-19 大流行加剧了医疗保健需求，并导致超额死亡，尤其是在社会经济地位较低的群体中。本研究描述了在荷兰，COVID-19 检测、医疗保健使用和死亡率的路径上，社会经济差异的出现。
这是一项回顾性的荷兰基于人群的研究，结合了 2020 年 6 月至 2020 年 12 月期间个人社会经济特征、COVID-19 管理测试、测试结果、全科医生（GP）咨询、住院、重症监护病房（ICU）入院和死亡率的个体登记数据。对于每个结果衡量标准，使用对数链接二项式回归模型估计收入组之间的相对差异。此外，回归模型通过 ICU/医院入院、测试管理和测试结果的差异来解释 COVID-19 死亡率的社会经济差异。
在荷兰人群中，与最高收入组相比，最低收入组的检测概率较低（RR=0.61），检测阳性的风险较低（RR=0.77）。然而，在至少进行了一次 COVID-19 测试的人群中，最低收入组检测阳性的风险较高（RR=1.40）。低收入群体住院和 ICU 入院的可能性更高（RR=2.11 和 RR=2.46）。最低收入组 COVID-19 死亡率的风险几乎高出四倍（RR=3.85），这部分可以通过住院和 ICU 入院的风险较高来解释，而不是测试管理或结果的差异。
我们的研究结果表明，社会经济差异在护理路径的每个步骤中变得更加明显，最终导致死亡率的巨大差距。这突显了加强社会保障和福祉政策以及将健康公平纳入大流行病防范计划的必要性。
