基于加拿大安大略省尼马特韦-利托那韦第一年使用的社会人口学预测因子评估公平获取：一项基于人群的生态学研究。

IF 2.6 4区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Canadian Journal of Public Health-Revue Canadienne De Sante Publique Pub Date : 2026-04-13 DOI:10.17269/s41997-026-01189-8

Meagan Lacroix, Bradley J Langford, Cynthia Chen, Jun Wang, Mina Tadrous, Nick Daneman, Valerie Leung, Tara Gomes, Lindsay Friedman, Peter Daley, Kevin A Brown, Kevin L Schwartz

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引用次数: 0

摘要

目的：推荐使用尼马特韦-利托那韦预防高危患者感染SARS-CoV-2后的严重后果。我们的目的是确定在不同社会人口统计学群体中是否存在获得尼马特韦-利托那韦的不平等。方法：研究人员于2022年4月4日至2023年4月3日在加拿大安大略省前方分选区（FSA）对尼马特瑞韦-利托那韦配剂进行了种群生态学研究。我们的主要终点是每10万人中nmatrelvir -ritonavir的fda级分配率。使用负二项模型计算9个社会人口学变量（收入、少数族裔、必要工作者、家庭规模、教育程度、公民身份、就业率、社会援助和语言水平）的粗比率和调整后的95%置信区间（ci），并对7个人口统计学/临床人口水平变量(年龄、性别、合并症、免疫功能低下、COVID-19疫苗接种、长期护理居民、SARS-CoV-2 PCR检测阳性百分比)。结果：最终队列包括513名fsa， 12,911,594名居民，其中127,123名（0.98%）接受了nirmatrelvir-ritonavir治疗，12,784,471名（99.02%）未接受。在fsa中有18倍的差异，每10万人中有133-2417张处方。在调整后的模型中，低收入居民比例较高的地区(调整率比（RRadj) = 0.98 (95% CI 0.97, 1.00, p = 0.014)）和高等教育程度较低的地区（RRadj = 0.98 (95% CI 0.97, 1.00, p = 0.044)）的分配率显著较低。其他社会人口学变量并没有显著降低尼马特韦-利托那韦的使用。结论：这项全省范围的研究显示，在安大略省低收入和中等教育程度较低的人群中，尼马特瑞韦-利托那韦的分配存在较小的不平等，这与尼马特瑞韦-利托那韦的使用较少有关。研究结果强调了解决公平获得治疗未来流行病的障碍的重要性。

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Evaluating equitable access based on sociodemographic predictors of nirmatrelvir-ritonavir use during the first year of availability in Ontario, Canada: A population-based ecological study.

Objectives: Nirmatrelvir-ritonavir is recommended to prevent severe outcomes due to SARS-CoV-2 infection in high-risk patients. Our objective was to determine if inequities existed in access to nirmatrelvir-ritonavir across sociodemographic groups.

Methods: We conducted a population-based ecological study of nirmatrelvir-ritonavir dispenses in Ontario, Canada, forward sortation areas (FSA) from April 4, 2022, to April 3, 2023. Our primary outcome was the FSA-level dispense rate of nirmatrelvir-ritonavir per 100,000 population. A negative binomial model was used to calculate crude and adjusted rate ratios with 95% confidence intervals (CIs) for nine sociodemographic variables (income, visible minority, essential worker, household size, education, citizenship, employment rate, social assistance, and language proficiency), adjusted for seven demographic/clinical population-level variables (age, sex, comorbidities, immunocompromised, COVID-19 vaccination, long-term care residents, and percent SARS-CoV-2 PCR test positivity).

Results: The final cohort included 513 FSAs, 12,911,594 residents-127,123 (0.98%) who received and 12,784,471 (99.02%) who did not receive nirmatrelvir-ritonavir. There was an 18-fold variation across FSAs, 133-2417 prescriptions per 100,000 population. In the adjusted model, dispensing rates were significantly lower in regions with higher proportions of residents with low income (adjusted rate ratio (RR_adj) = 0.98 (95% CI 0.97, 1.00, p = 0.014)) and less post-secondary education (RR_adj = 0.98 (95% CI 0.97, 1.00, p = 0.044)). Other sociodemographic variables did not have significantly lower nirmatrelvir-ritonavir use.

Conclusion: This province-wide study revealed small inequities in nirmatrelvir-ritonavir dispensing across Ontario neighborhoods with lower income and lower post-secondary education populations associated with less nirmatrelvir-ritonavir use. The findings highlight the importance of addressing barriers for equitable access to therapeutics for future pandemics.

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来源期刊

Canadian Journal of Public Health-Revue Canadienne De Sante Publique PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-

CiteScore

6.10

自引率

4.70%

发文量

128

期刊介绍： The Canadian Journal of Public Health is dedicated to fostering excellence in public health research, scholarship, policy and practice. The aim of the Journal is to advance public health research and practice in Canada and around the world, thus contributing to the improvement of the health of populations and the reduction of health inequalities. CJPH publishes original research and scholarly articles submitted in either English or French that are relevant to population and public health. CJPH is an independent, peer-reviewed journal owned by the Canadian Public Health Association and published by Springer. Énoncé de mission La Revue canadienne de santé publique se consacre à promouvoir l’excellence dans la recherche, les travaux d’érudition, les politiques et les pratiques de santé publique. Son but est de faire progresser la recherche et les pratiques de santé publique au Canada et dans le monde, contribuant ainsi à l’amélioration de la santé des populations et à la réduction des inégalités de santé. La RCSP publie des articles savants et des travaux inédits, soumis en anglais ou en français, qui sont d’intérêt pour la santé publique et des populations. La RCSP est une revue indépendante avec comité de lecture, propriété de l’Association canadienne de santé publique et publiée par Springer.