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COVID-19 and Public Health Restrictions Disproportionately Affected the Vulnerable: A Population Study in Sydney, Australia
21 Pages Posted: 29 Oct 2022
More...Abstract
Background: There is growing evidence that the COVID-19 pandemic disproportionately affected minority and lower socioeconomic groups. These groups have limited access to healthcare and social security, work in high-risk jobs, and have higher rates of comorbidities associated with poor outcomes from COVID-19. This study quantifies the impact of individual demographics, socioeconomic factors, and public health measures on COVID-19 health outcomes in a large population.
Method: The primary outcome of interest was COVID-19 infection. Secondary outcomes were testing for COVID-19, hospitalisation due to COVID-19 and death due to COVID-19. Demographics, socioeconomic factors, and COVID-19 outcomes for all 650,000 residents of the Sydney Local Health District from June 2021 to February 2022 were identified from the state’s Notifiable Conditions Information Management System (NCIMS) and linked to Australian Census data. Logistic regression and Cox proportional hazards models were generated for all outcomes for different periods of public health restrictions.
Findings: During strict public health measures, older individuals had a lower risk of infection, with those aged 80 years and over having two thirds the risk of infection compared to the reference group of 30 to 39 years old (hazards ratio 0.64, 95%CI 0.54-0.75); and those living in areas of lower socioeconomic status (SES) having a higher risk of infection, with the lowest areas having seven times the risk compared to the highest areas (HR 7.09, 6.19-8.12). The risk of infection was also higher for males (HR 1.34 1.27-1.40); those living in areas with higher household sizes (HR 1.56, 1.37-1.79); and areas where the most common foreign country of birth was in South Asia (HR 1.17, 1.07-1.29), South East Asia (HR 1.20, 1.07-1.36) and the Middle East and North Africa (HR 1.67, 1.47-1.90). During relaxed restrictions, differences between age groups, socioeconomic status, sexes, household sizes, and country of birth attenuated, but remained significant. Individuals living in areas with lower SES had lower odds of COVID-19 testing (odds ratio 0.31, 0.30-0.33), and higher odds of hospitalisation (OR 2.02, 1.71-2.38) and death (OR 4.22, 2.49-7.17) due to COVID-19. Areas where the most common foreign country of birth was not in Europe had reduced odds of testing, but no difference in odds of hospitalisation or death. The Omicron variant of COVID-19 was associated with lower odds of hospitalisation (OR 0.20, 0.18-0.21) and death (OR 0.24, 0.19-0.29).
Interpretation: Strict public health measures adopted during the COVID-19 pandemic resulted in greater inequity. Policy and decision-makers should enhance efforts to achieve equity in relation to public health measures adopted for disease control. The challenge is to strengthen, scale, and sustain community engagement and relationships initiated during COVID-19 outbreaks.
Funding: The first author (GU) is funded by a National Health Medical Research Centre Integrated
Health and Social Health Centre for Research Excellence (APP1198477). JE is the Principal
Chief Investigator of this grant. CHS, MC, IK, JG, AP and PH are also Chief Investigators on
this grant.
Declaration of Interest: None declared.
Ethical Approval: Ethics approval for the current study was granted by the Research Ethics & Governance Office, Royal Prince Alfred Hospital, Sydney Local Health District (X20-0426, 2020/ETH02492, X21-0180, 2021/ETH00947).
Keywords: Public health measures, COVID-19, social factors, testing, risk of infection, death, hospitalisation, vulnerable populations
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