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Publications

Journal Article Ppublish

PubMed: 39676287 DOI: 10.1093/pubmed/fdae310

A syndemic approach to the study of Covid-19-related death: a cohort study using UK Biobank data.

J Public Health (Oxf) 47(1):e77-e85

Authors: Daniela Fonseca de Freitas, Kamaldeep Bhui, Christophe Clesse, Uzma Zahid, Roisin Mooney, Easter Joury, Richard D Hayes, Mizanur Khondoker

Affiliations

  • CHiMES Collaborative, Department of Psychiatry, Medical Sciences Division, University of Oxford, Oxford, UK.
  • Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
  • National Health Service England, London, UK.
  • Nuffield Department of Primary Care Health Sciences, Wadham College, University of Oxford. WPA Collaborating Centre, Oxford, UK.
  • East London and Oxford Health National Health Service Foundation Trusts, Oxford Health Biomedical Research Centre, Global Policy Institute, Queen Mary University of London, London, UK.
  • Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
  • School of Psychology, Whitelands College, University of Roehampton, London, UK.
  • Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
  • Dental Public Health, Faculty of Medicine and Dentistry, Queen Mary University of London and Barts Health National Health Service Trust, London, UK.
  • Norwich Medical School, University of East Anglia, Norwich, UK.

Abstract

BACKGROUND

The Covid-19 pandemic showed higher infection, severity and death rates among those living in poorer socioeconomic conditions. We use syndemic theory to guide the analyses to investigate the impact of social adversity and multiple long-term conditions (MLTC) on Covid-19 mortality.

METHODS

The study sample comprised 154 725 UK Biobank participants. Structural equation modeling was used to investigate pathways between traumatic events, economic deprivation, unhealthy behaviors, MLTC, for Covid-19 mortality. Cox regression analysis was used to investigate MLTC and Covid-19 mortality. We also tested effect modification by traumatic events, economic deprivation and unhealthy behaviors.

RESULTS

Covid-19 mortality (n = 186) was directly explained by overall level of MLTC. Economic deprivation and unhealthy behaviors contributed to Covid-19 death indirectly via their negative impact on MLTC. The risk for Covid-19 mortality grew exponentially for every quintile of predicted scores of MLTC. The presence of traumatic events, economic deprivation or unhealthy behaviors did not modify the impact of MLTC on Covid-19 mortality.

CONCLUSIONS

Results suggest a serially causal pathway between economic deprivation and unhealthy behaviors leading to MLTC, which increased the risk of Covid-19 mortality. Policies to tackle the social determinants of health and to mitigate the negative impact of multimorbidity are needed.

MeSH

Mortality, Cohort Studies, Public Health, Covid-19, Multimorbidity, Epidemics, Syndemic