Sharma Shambhavi, Li Huiqi, Löve Jesper, Nwaru Chioma, Gisslén Magnus, Byfors Sara, Hammar Niklas, Nilsson Anton, Björk Jonas, Nyberg Fredrik, Bonander Carl
School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Eur J Public Health. 2024 Dec 1;34(6):1066-1072. doi: 10.1093/eurpub/ckae145.
During the coronavirus disease 2019 (COVID-19) pandemic, Sweden emphasized voluntary guidelines over mandates. We exploited a rapid change and reversal of the Public Health Agency of Sweden's COVID-19 testing guidelines for vaccinated and recently infected individuals as a quasi-experiment to examine sociodemographic differences in the response to changes in pandemic guidelines. We analyzed daily polymerase chain reaction tests from 1 October 2021 to 15 December 2021, for vaccinated or recently infected adults (≥20 years; n = 1 596 321) from three Swedish regions (Stockholm, Örebro, and Dalarna). Using interrupted time series analysis, we estimated abrupt changes in testing rates at the two dates when the guidelines were changed (1 November and 22 November). Stratified analysis and meta-regression were employed to explore sociodemographic differences in the strength of the response to the guideline changes. Testing rates declined substantially when guideline against testing of vaccinated and recently infected individuals came into effect on 1 November [testing rate ratio: 0.50 (95% confidence interval, CI 0.41, 0.61)], and increased again from these lowered levels by a similar amount upon its reversal on 22 November [testing rate ratio: 2.19 (95% CI: 1.69, 2.85)]. Being Sweden-born, having higher household income, or higher education, were all associated with a stronger adherent response to the guideline changes. Adjusting for stratum-specific baseline testing rates and test-positivity did not influence the results. Our findings suggest that the population was responsive to the rapid changes in testing guidelines, but with clear sociodemographic differences in the strength of the response.
在2019年冠状病毒病（COVID-19）大流行期间，瑞典强调自愿性指导方针而非强制命令。我们利用瑞典公共卫生局针对接种疫苗者和近期感染者的COVID-19检测指导方针的迅速变化和逆转作为一项准实验，来研究对大流行指导方针变化的反应中的社会人口学差异。我们分析了2021年10月1日至2021年12月15日来自瑞典三个地区（斯德哥尔摩、厄勒布鲁和达拉纳）的接种疫苗或近期感染的成年人（≥20岁；n = 1596321）的每日聚合酶链反应检测情况。使用中断时间序列分析，我们估计了在指导方针改变的两个日期（11月1日和11月22日）检测率的突然变化。采用分层分析和元回归来探索对指导方针变化反应强度的社会人口学差异。当11月1日针对接种疫苗者和近期感染者的检测指导方针生效时，检测率大幅下降[检测率比：0.50（95%置信区间，CI 0.41，0.61）]，而在11月22日指导方针逆转后，检测率又从这些较低水平再次上升了类似幅度[检测率比：2.19（95% CI：1.69，2.85）]。出生在瑞典、家庭收入较高或受教育程度较高，都与对指导方针变化更强的依从性反应相关。调整特定层的基线检测率和检测阳性率并不影响结果。我们的研究结果表明，人群对检测指导方针的迅速变化有反应，但在反应强度上存在明显的社会人口学差异。
