World Bank, Santiago, Chile.
Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
Int J Equity Health. 2024 Nov 30;23(1):259. doi: 10.1186/s12939-024-02337-7.
Latin America and the Caribbean (LAC) is among the most unequal regions in the world in terms of wealth and household income. Such inequalities have been shown to influence different outcomes during the COVID-19 pandemic, including the disruption of routine health services. The aim of this paper is to examine socioeconomic inequalities in household experiences of healthcare disruption in LAC countries from mid-2020 to late 2021.
We used household-level data from the COVID-19 High Frequency Phone Surveys (HFPS), conducted in 14 LAC countries in one round in 2020 and 24 countries in two rounds in 2021. Ordinary least square and Logit multivariate regressions were conducted to examine the correlation between reported healthcare disruptions with household characteristics for 2020 and 2021. Since household income levels were not directly collected in the HPFS, we created an index of inequality and estimated the relative index of inequality.
When analyzing 2020-2021 together, reported healthcare disruptions were lower if the respondent was employed or did not report lack of food in the last month; if the household had more people aged 65 or older or more rooms to sleep in. When analyzed separately in 2020 and 2021, having more people aged 65 or older or not experiencing food insecurity remained stable factors for lower odds of disruption in both years. In addition, being employed was associated with lower odds of disruption in 2020, while being male or having more rooms to sleep in were associated with lower odds of disruption in 2021. Regarding wealth differences in 2021 (it was not possible to compute it for 2020), households with the lowest wealth were 27.3% more likely to report a care disruption than households with the highest wealth.
The socioeconomic status of households in LAC was a relevant factor in explaining the disruption of healthcare during the COVID19 pandemic, with a clear social gradient where the wealthier a household, the less likely it was to experience disruption of care. Food security, employment, and gender policies should be integral to preparing for and responding to future shocks such as pandemics. Prioritizing the most affected populations, like the elderly during COVID-19, can enhance the health system effectiveness.
拉丁美洲和加勒比地区（LAC）在财富和家庭收入方面是世界上最不平等的地区之一。这些不平等现象已被证明会影响 COVID-19 大流行期间的不同结果，包括常规卫生服务的中断。本文旨在研究 2020 年中期至 2021 年底 LAC 国家家庭在医疗保健中断方面的社会经济不平等现象。
我们使用了来自 COVID-19 高频电话调查（HFPS）的家庭层面数据，该调查在 2020 年一轮和 2021 年两轮中在 14 个 LAC 国家进行。为了研究报告的医疗保健中断与 2020 年和 2021 年家庭特征之间的相关性，我们进行了普通最小二乘法和 Logit 多元回归分析。由于 HFPS 中没有直接收集家庭收入水平，我们创建了一个不平等指数，并估计了相对不平等指数。
当分析 2020-2021 年的数据时，如果受访者受雇或在上个月没有报告缺乏食物，如果家庭中有更多 65 岁或以上的人或更多的睡眠空间，报告的医疗保健中断的可能性就会降低。当分别在 2020 年和 2021 年进行分析时，65 岁或以上的人更多或没有经历粮食不安全的情况仍然是两年中降低中断可能性的稳定因素。此外，在 2020 年，受雇与中断的可能性较低相关，而在 2021 年，男性或拥有更多的睡眠空间与中断的可能性较低相关。关于 2021 年的财富差异（不可能计算 2020 年的财富差异），财富最低的家庭报告护理中断的可能性比财富最高的家庭高 27.3%。
LAC 家庭的社会经济地位是解释 COVID19 大流行期间医疗保健中断的一个相关因素，存在明显的社会梯度，即家庭越富裕，越不可能经历医疗保健中断。粮食安全、就业和性别政策应该成为应对未来冲击（如大流行）的重要组成部分。在 COVID-19 期间，优先考虑最受影响的人群，如老年人，可以提高卫生系统的效率。
