Journal Article Epublish 2 citations
PubMed: 39529714 DOI: 10.3389/fpubh.2024.1426898
Social health gradient and risk factors among patients hospitalized for COVID-19 and pre-pandemic respiratory infections. A linked national individual case-control study in Belgium.
Front Public Health 12:1426898
Authors: Arnaud Bruyneel, Jérôme E Dauvergne, Nicolas Dauby, Jean-Christophe Goffard, Andrea Rea, Judith Racape
Affiliations
- Hospital Management and Nursing Research Department, Research Center in Health Economics, School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium.
- Department of Anaesthesiology and Critical Care, CHU Nantes, Laënnec Hospital, Nantes Université, Nantes, France.
- Department of Infectious Diseases, Centre Hospitalier Universitaire (CHU) Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium.
- Research Center in Environmental Health, School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium.
- Department of Internal Medicine, Erasmus Hospital, Université Libre de Bruxelles, Brussels, Belgium.
- Group for Research on Ethnic Relations, Migrations and Equality, Faculty of Philosophy and Social Sciences, Université Libre de Bruxelles (ULB), Brussels, Belgium.
- Chair in Health and Precarity, Faculty of Medicine, Université Libre de Bruxelles (ULB), Brussels, Belgium.
- Research Center in Epidemiology, Biostatistics and Clinical Research, School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium.
Abstract
Introduction
The literature establishes a clear social gradient in health for transmissible respiratory diseases. However, this gradient's extent remains largely unexplored in the context of COVID-19, and it is uncertain whether the pandemic has exacerbated this gradient. The study aims to compare the socio-economic profiles and comorbidities during the COVID-19 pandemic with a control population affected by viral pneumonia/respiratory disease in 2019.
Methods
This case-control study analyzed linked data from all patients hospitalized for COVID-19 in 2020 ( = 22,087) and for respiratory diseases in 2019 ( = 7,586). Socio-economic data from the social security database were linked to clinical data from the hospital registry. We analyzed the socio-demographic and clinical factors associated with COVID-19 hospitalization (control group, wave 1, and wave 2) using multinomial regressions and logistic regression models and the length of stay during hospitalization using binomial negative regressions.
Results
A social health gradient was observed in both the COVID-19 and control groups, with a significant increase across waves for COVID-19 (p-trend < 0.0001). Men, people over the age of 45, those with comorbidities, high population density, lower income, lower socio-economic status, and people living in Brussels capital were at higher risk of COVID-19 hospitalization and longer length of stay compared to the control group. Except for sub-Saharan Africans, all patients of foreign nationality had a significantly increased risk of hospitalization ( < 0.001), but a shorter length of stay compared to Belgians.
Conclusion
The socio-health gradient for COVID-19 followed the same pattern as that observed in pre-pandemic respiratory diseases, intensifying in the second wave and among the most deprived groups. This study emphasizes the importance of collecting social data alongside clinical data for a better understanding of social health inequalities and for tailoring health prevention policies.
MeSH
Comorbidity, Hospitalization, Case-Control Studies, Health Status Disparities, Respiratory Tract Infections, Public Health, Covid-19, Length Of Stay, Risk Factors, Pandemics, Infections, Socioeconomic Factors