当地卫生领导人和世界卫生组织总干事都观察到,COVID-19“没有歧视。“尽管如此,低社会经济地位的人在感染者中的比例过高,类似于歧视。这项基于人群的回顾性队列研究调查了安大略省的COVID-19病例数和公共资助的医疗保健费用,加拿大,注重边缘化。
从2020年1月1日至2020年6月30日,首次检测出严重急性呼吸道综合症冠状病毒2阳性的个体与管理数据库相关联,并与阴性/未测试的对照进行匹配。估计诊断前后30天的平均净(COVID-19-归属)成本,以及年龄阶层之间的差异,性别,合并症,和边缘化的措施进行了评估,使用方差分析检验。
我们包括28893例COVID-19(平均年龄54岁,56%女性)。大多数病例留在社区(20.545,71.1%)或长期护理机构(4478,15.5%),944例(3.3%)和2926例(10.1%)住院,有和没有重症监护室,分别。在边缘化阶层中,病例数出现偏差,低收入社区的病例数增加了2到7倍,物质匮乏,和最高的种族集中。男性诊断后的平均净成本较高(4752美元vs女性2520美元)和合并症较高的病例(1394-7751美元)(两者P<.001),但大多数边缘化维度的水平相似(范围为3232-3737美元,所有P≥.19)。
这项研究表明,不平等地将资源分配给边缘化个人可能会改善结果的平等。它强调了降低边缘化人群感染COVID-19风险的重要性,以降低总体成本并提高系统能力。
Local health leaders and the Director General of the World Health Organization alike have observed that COVID-19 \"does not discriminate.\" Nevertheless, the disproportionate representation of people of low socioeconomic status among those infected resembles discrimination. This population-based retrospective cohort study examined COVID-19
case counts and publicly funded healthcare costs in Ontario, Canada, with a focus on marginalization.
Individuals with their first positive severe acute respiratory syndrome coronavirus 2 test from January 1, 2020 to June 30, 2020, were linked to administrative databases and matched to negative/untested controls. Mean net (COVID-19-attributable) costs were estimated for 30 days before and after diagnosis, and differences among strata of age, sex, comorbidity, and measures of marginalization were assessed using analysis of variance tests.
We included 28 893 COVID-19 cases (mean age 54 years, 56% female). Most cases remained in the community (20 545, 71.1%) or in long-term care facilities (4478, 15.5%), whereas 944 (3.3%) and 2926 (10.1%) were hospitalized, with and without intensive care unit, respectively.
Case counts were skewed across marginalization strata with 2 to 7 times more cases in neighborhoods with low income, high material deprivation, and highest ethnic concentration. Mean net costs after diagnosis were higher for males ($4752 vs $2520 for females) and for cases with higher comorbidity ($1394-$7751) (both P < .001) but were similar across levels of most marginalization dimensions (range $3232-$3737, all P ≥ .19).
This study suggests that allocating resources unequally to marginalized individuals may improve equality in outcomes. It highlights the importance of reducing risk of COVID-19 infection among marginalized individuals to reduce overall costs and increase system capacity.