Investigating the contribution of socio-economic position to ethnic inequalities in severe COVID-19 outcomes: population-based mediation analyses of national linked Scottish data.

IF 3.9 3区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Sarah Amele, Eliud Kibuchi, Ronan McCabe, Evangelia Demou, Alastair H Leyland, Kirsten Hainey, Igor Rudan, Amanj Kurdi, Colin R Simpson, Lewis D Ritchie, Colin McCowan, Ting Shi, Patricia Irizar, Laia Becares, Aziz Sheikh, Anna Pearce, Srinivasa Vittal Katikireddi
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Abstract

We quantified the extent to which socio-economic position (SEP) contributed to ethnic inequalities in severe COVID-19 outcomes (hospitalization or death) in Scotland. We used linked 2011 Scottish Census and health records to assess whether ethnic inequalities were mediated by different SEP measures: area deprivation, educational status, household composition, and multigenerational household. We considered disaggregated ethnicities 'White Scottish', 'White British or Irish', 'Other White', 'South Asian', 'African, Caribbean, or Black', and 'Other'. We applied marginal structural models to estimate causal pathways. Of the 3 297 205 individuals analysed, 38 213 (1.2%) had severe COVID-19 outcomes. South Asians had elevated risk of severe COVID-19 compared to White Scottish (hazard ratio: 1.7; 95% confidence interval: 1.5-1.9), while White British or Irish (hazard ratio: 0.7; confidence interval: 0.6-08) and other White (hazard ratio: 0.8; confidence interval: 0.7-0.9) had reduced risk. When holding area deprivation constant, the risk of severe COVID-19 declined by 16.5% for South Asians and 49.2% for White British or Irish; but increased for other White (75.4%). When holding education constant, the risk of severe COVID-19 reduced by 24.8% for White British or Irish and 20.6% for other White; but increased by 74.6% for South Asians. Only a slight change in risk was observed for the South Asians after holding household size and multigenerational household constant. Risk estimates for African, Caribbean or Black, and other groups were underpowered. SEP measures differed substantially in the extent to which they mediated ethnic inequalities in severe COVID-19. This highlights the necessity of addressing multiple dimensions of SEP that drive ethnic inequalities.

Abstract Image

调查社会经济地位对COVID-19严重后果中种族不平等的影响:苏格兰国家相关数据的基于人口的中介分析。
我们量化了社会经济地位(SEP)对苏格兰严重COVID-19结果(住院或死亡)的种族不平等的影响程度。我们使用关联的2011年苏格兰人口普查和健康记录来评估种族不平等是否由不同的SEP措施介导:区域剥夺、教育状况、家庭组成和多代家庭。我们将种族分类为“苏格兰白人”、“英国或爱尔兰白人”、“其他白人”、“南亚人”、“非洲人、加勒比人或黑人”和“其他”。我们应用边际结构模型来估计因果路径。在分析的3297205例个体中,38213例(1.2%)有严重的COVID-19结局。与苏格兰白人相比,南亚人患严重COVID-19的风险更高(风险比:1.7;95%可信区间:1.5-1.9),而白人英国人或爱尔兰人(风险比:0.7;置信区间:0.6-08)和其他白色(风险比:0.8;置信区间:0.7-0.9)风险降低。在保持区域剥夺不变的情况下,南亚人患严重COVID-19的风险下降了16.5%,英国白人或爱尔兰人下降了49.2%;但其他白人增加了(75.4%)。在保持教育水平不变的情况下,英国或爱尔兰白人患严重COVID-19的风险降低了24.8%,其他白人降低了20.6%;但南亚人增加了74.6%。在保持家庭规模和几代同堂的家庭不变后,南亚人的风险只有轻微的变化。对非洲人、加勒比人、黑人和其他群体的风险估计不足。SEP措施在严重COVID-19中介导种族不平等的程度上存在很大差异。这凸显了解决导致种族不平等的SEP的多个维度的必要性。
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来源期刊
European Journal of Public Health
European Journal of Public Health 医学-公共卫生、环境卫生与职业卫生
CiteScore
5.60
自引率
2.30%
发文量
2039
审稿时长
3-8 weeks
期刊介绍: The European Journal of Public Health (EJPH) is a multidisciplinary journal aimed at attracting contributions from epidemiology, health services research, health economics, social sciences, management sciences, ethics and law, environmental health sciences, and other disciplines of relevance to public health. The journal provides a forum for discussion and debate of current international public health issues, with a focus on the European Region. Bi-monthly issues contain peer-reviewed original articles, editorials, commentaries, book reviews, news, letters to the editor, announcements of events, and various other features.
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