Abstract

Introduction

The COVID-19 pandemic exacerbated healthcare needs and caused excess mortality, especially among lower socioeconomic groups. This study describes the emergence of socioeconomic differences along the COVID-19 pathway of testing, healthcare use and mortality in the Netherlands.

Methodology

This retrospective observational Dutch population-based study combined individual-level registry data from June 2020 to December 2020 on personal socioeconomic characteristics, COVID-19 administered tests, test results, general practitioner (GP) consultations, hospital admissions, Intensive Care Unit (ICU) admissions and mortality. For each outcome measure, relative differences between income groups were estimated using log-link binomial regression models. Furthermore, regression models explained socioeconomic differences in COVID-19 mortality by differences in ICU/hospital admissions, test administration and test results.

Results

Among the Dutch population, the lowest income group had a lower test probability (RR = 0.61) and lower risk of testing positive (RR = 0.77) compared to the highest income group. However, among individuals with at least one administered COVID-19 test, the lowest income group had a higher risk of testing positive (RR = 1.40). The likelihood of hospital admissions and ICU admissions were higher for low income groups (RR = 2.11 and RR = 2.46, respectively). The lowest income group had an almost four times higher risk of dying from COVID-19 (RR = 3.85), which could partly be explained by a higher risk of hospitalization and ICU admission, rather than differences in test administration or result.

Discussion

Our findings indicated that socioeconomic differences became more pronounced at each step of the care pathway, culminating to a large gap in mortality. This underlines the need for enhancing social security and well-being policies and incorporation of health equity in pandemic preparedness plans.

中文翻译：

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从测试到休息：评估荷兰 COVID-19 护理路径中的社会经济差异

摘要

介绍

COVID-19 大流行加剧了医疗保健需求并导致死亡率过高，特别是在社会经济地位较低的群体中。本研究描述了荷兰在 COVID-19 检测、医疗保健使用和死亡率方面出现的社会经济差异。

方法

这项以荷兰人口为基础的回顾性观察性研究结合了 2020 年 6 月至 2020 年 12 月的个人登记数据，涉及个人社会经济特征、COVID-19 测试、测试结果、全科医生 (GP) 咨询、住院情况、重症监护病房 (ICU)入院率和死亡率。对于每个结果指标，使用对数链接二项式回归模型估计收入组之间的相对差异。此外，回归模型通过 ICU/医院入院、测试管理和测试结果的差异解释了 COVID-19 死亡率的社会经济差异。

结果

在荷兰人口中，与最高收入群体相比，最低收入群体的检测概率较低（RR = 0.61），检测呈阳性的风险也较低（RR = 0.77）。然而，在至少接受过一次 COVID-19 检测的个人中，最低收入群体检测呈阳性的风险较高（RR = 1.40）。低收入群体入院和入住 ICU 的可能性较高（分别为 RR = 2.11 和 RR = 2.46）。最低收入群体死于 COVID-19 的风险几乎高出四倍（RR = 3.85），部分原因是住院和入住 ICU 的风险较高，而不是测试管理或结果的差异。

讨论

我们的研究结果表明，社会经济差异在护理途径的每一步都变得更加明显，最终导致死亡率的巨大差距。这凸显了加强社会保障和福祉政策以及将健康公平纳入大流行病防备计划的必要性。