Persaud Sydney, Fitzgerald Michael, Hawken Steven, Tanuseputro Peter, Boucher Lisa, Petrcich William, Wellman Martin, Webber Colleen, Shoemaker Esther, Ducharme Robin, Dahrouge Simone, Myran Daniel, Bayoumi Ahmed M, Wanigaratne Susitha, Bloch Gary, Ponka David, Smith Brendan T, Lofters Aisha, Zygmunt Austin, MacLeod Krystal Kehoe, Turcotte Luke A, Sander Beate, Howard Michelle, Funnell Sarah, Rayner Jennifer, Kitagawa Kurtis, Ibrahim Sureya, Kendall Claire E
Bruyère Health Research Institute, Ottawa, Ontario, Canada.
ICES, Ottawa, Ontario, Canada.
Dialogues Health. 2024 Oct 29;5:100197. doi: 10.1016/j.dialog.2024.100197. eCollection 2024 Dec.
The COVID-19 pandemic highlighted and exacerbated health inequities worldwide. While several studies have examined the impact of individual social factors on COVID infection, our objective was to examine how interactions of social factors were associated with the risk of testing positive for SARS-CoV-2 during the first two years of the pandemic.
We conducted an observational cohort study using linked health administrative data for Ontarians tested for SARS-CoV-2 between January 1st, 2020, and December 31st, 2021. We constructed multivariable models to examine the association between SARS-CoV-2 positivity and key variables including immigration status (immigrants vs. other Ontarians), and neighbourhood variables for household size, income, essential worker status, and visible minority status. We report main and interaction effects using odds ratios and predicted probabilities, with age and sex controlled in all models.
Of 6,575,523 Ontarians in the cohort, 88.5 % tested negative, and 11.5 % tested positive for SARS-CoV-2. In all models, immigrants and those living in neighbourhoods with large average household sizes had greater odds of testing positive for SARS-CoV-2. The strength of these associations increased with increasing levels of neighbourhood marginalization for income, essential worker proportion and visible minority proportion. We observed little change in the probability of testing positive across neighbourhood income quintiles among other Ontarians who live in neighbourhoods with smaller households, but a large change in probability among other Ontarians who live in neighbourhoods with larger households.
Our study found that SARS-CoV-2 positivity was greater among people with certain combinations of social factors, but in all cases the probability of testing positive was consistently greater for immigrants than for other Ontarians. Examining interactions of social factors can provide a more nuanced and more comprehensive understanding of health inequity than examining factors separately.
新冠疫情凸显并加剧了全球范围内的健康不平等。虽然已有多项研究探讨了个体社会因素对新冠感染的影响，但我们的目标是研究社会因素之间的相互作用如何与疫情头两年感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）呈阳性的风险相关联。
我们利用2020年1月1日至2021年12月31日期间安大略省接受SARS-CoV-2检测的人群的健康管理关联数据，开展了一项观察性队列研究。我们构建了多变量模型，以检验SARS-CoV-2阳性与关键变量之间的关联，这些变量包括移民身份（移民与其他安大略人）以及家庭规模、收入、一线工作者身份和少数族裔身份等社区变量。我们使用优势比和预测概率报告主要效应和交互效应，并在所有模型中对年龄和性别进行了控制。
该队列中的6575523名安大略人中，88.5%的检测结果为阴性，11.5%的检测结果为SARS-CoV-2阳性。在所有模型中，移民以及居住在平均家庭规模较大社区的人群感染SARS-CoV-2呈阳性的几率更高。随着社区在收入、一线工作者比例和少数族裔比例方面边缘化程度的增加，这些关联的强度也随之增强。我们发现，居住在家庭规模较小社区的其他安大略人，其在社区收入五分位数中检测呈阳性的概率变化不大，但居住在家庭规模较大社区的其他安大略人，其检测呈阳性的概率变化很大。
我们的研究发现，具有特定社会因素组合的人群中SARS-CoV-2阳性率更高，但在所有情况下，移民检测呈阳性的概率始终高于其他安大略人。与单独研究各个因素相比，研究社会因素之间的相互作用能够更细致、更全面地理解健康不平等问题。
