Cheetham Nathan J, Bowyer Vicky, García María Paz, Bowyer Ruth C E, Carpentieri J D, Guise Andy, Thompson Ellen J, Sudre Carole H, Molteni Erika, Antonelli Michela, Penfold Rose S, Harvey Nicholas R, Canas Liane S, Rjoob Khaled, Murray Benjamin, Kerfoot Eric, Hammers Alexander, Ourselin Sebastien, Duncan Emma L, Steves Claire J
Department Of Twin Research & Genetic Epidemiology, King's College London, London, UK.
The Alan Turing Institute, London, UK.
BMJ Public Health. 2025 Mar 20;3(1):e001166. doi: 10.1136/bmjph-2024-001166. eCollection 2025 Jan.
INTRODUCTION: Social gradients in COVID-19 exposure and severity have been observed internationally. Whether combinations of pre-existing social factors, particularly those that confer cumulative advantage and disadvantage, affect recovery from ongoing symptoms following COVID-19 and long COVID is less well understood. METHODS: We analysed data on self-perceived recovery following self-reported COVID-19 illness in two UK community-based cohorts, COVID Symptom Study Biobank (CSSB) (N=2548) and TwinsUK (N=1334). Causal effects of sociodemographic variables reflecting status prior to the COVID-19 pandemic on recovery were estimated with multivariable Poisson regression models, weighted for inverse probability of questionnaire participation and COVID-19 infection and adjusted for potential confounders. Associations between recovery and social strata comprising combinations of sex, education level and local area deprivation were estimated using the intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) approach. Further analyses estimated associations with variables reflecting experiences during the pandemic. RESULTS: Gradients in recovery from COVID-19 along the lines of social advantage were observed in intersectional MAIHDA models, with predicted probability of recovery lowest in female strata with lowest education and highest deprivation levels (CSSB: 55.1% (95% CI 44.0% to 65.1%); TwinsUK: 73.9% (95% CI 61.1% to 83.0%)) and highest in male strata with highest education and lowest deprivation levels (CSSB: 79.1% (95% CI 71.8% to 85.1%); TwinsUK: 89.7% (95% CI 82.5% to 94.1%)). Associations were not explained by differences in prepandemic health. Adverse employment, financial, healthcare access and personal experiences during the pandemic were also negatively associated with recovery. CONCLUSIONS: Inequalities in likelihood of recovery from COVID-19 were observed, with ongoing symptoms several months after coronavirus infection more likely for individuals with greater social disadvantage prior to the pandemic.
引言：在国际上已观察到新冠病毒感染及其严重程度方面存在社会梯度差异。对于既有的社会因素组合，尤其是那些带来累积优势和劣势的因素，是否会影响新冠病毒感染后持续症状的恢复以及长期新冠的恢复情况，人们了解较少。 方法：我们分析了英国两个基于社区的队列研究中自我报告感染新冠病毒后自我感知恢复情况的数据，即新冠症状研究生物样本库（CSSB）（N = 2548）和双胞胎英国队列（TwinsUK）（N = 1334）。使用多变量泊松回归模型估计了反映新冠疫情大流行之前状况的社会人口统计学变量对恢复的因果效应，并对问卷参与和新冠病毒感染的逆概率进行加权，同时对潜在混杂因素进行了调整。使用个体异质性和判别准确性的交叉多层分析（MAIHDA）方法估计了恢复情况与由性别、教育水平和当地贫困程度组合而成的社会阶层之间的关联。进一步分析估计了与反映疫情期间经历的变量之间的关联。 结果：在交叉MAIHDA模型中观察到了沿社会优势线的新冠病毒感染恢复梯度，教育程度最低且贫困程度最高的女性阶层恢复的预测概率最低（CSSB：55.1%（95%置信区间44.0%至65.1%）；双胞胎英国队列：73.9%（95%置信区间61.1%至83.0%）），而教育程度最高且贫困程度最低的男性阶层恢复的预测概率最高（CSSB：79.1%（95%置信区间71.8%至85.1%）；双胞胎英国队列：89.7%（95%置信区间82.5%至94.1%））。疫情前健康状况的差异并不能解释这些关联。疫情期间不利的就业、财务、医疗保健可及性和个人经历也与恢复呈负相关。 结论：观察到了新冠病毒感染恢复可能性方面的不平等现象，对于在疫情大流行之前社会劣势更大的个体，在冠状病毒感染数月后出现持续症状的可能性更高。
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