以色列第一波COVID-19大流行中公共卫生措施的时间、范围和结果以及社会经济指标的比较分析

IF 3.5 4区 医学 Q1 HEALTH POLICY & SERVICES
Amit Ginzburg, Deborah Barasche-Berdah, Orly Manor, Ronit Levine-Schnur, Ora Paltiel, Hagai Levine
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引用次数: 1

摘要

背景:在2019冠状病毒病(COVID-19)大流行早期,各国政府在面临不确定性时实施了特殊的公共卫生措施。本研究旨在比较以色列实施的缓解政策及其在第一波大流行中与其他国家实施的缓解政策的时机,并评估民主、信任、教育、经济实力和医疗储备等国家特征是否与决策相关。方法:采用国际通行的指标,于2020年1月1日~ 2020年6月30日采集50个国家的phm和流行前特征;并评估了它们之间的联系。对经济合作组织(OECD)成员国实施这些措施的时间进行了比较。单因素分析采用Log-rank检验。采用Cox回归来评估大流行前特征对措施实施时间的独立贡献。评估特定措施的时间与60天COVID-19死亡率之间的相关性。结果:以色列在实施10项措施中的8项的速度上排名经合组织的前三分之一。在单变量生存分析中,与经合组织中位数以上的国家相比,教育水平低于经合组织中位数的国家更有可能实施封锁(p值= 0.043),并关闭餐馆和娱乐场所(p值= 0.007)。在Cox回归模型中,控制地理位置,高于经合组织中位数的民主水平与实施封锁的时间较长相关(HR=0.35, 95% CI=0.14-0.88, p值=0.025)。同样,高水平的人均GDP与关闭学校呈负相关;高教育水平与餐馆和娱乐场所的关闭呈负相关。在控制地理位置的情况下,早期开始所有phm与60天内较低的死亡率相关。结论:以色列对这一流行病的最初反应相对较快,这可能是由于其地理位置的孤立而促成的。大流行前社会经济指数较低的国家更快地开始强制保持社会距离。早期开始PHMs与短期死亡率降低有关。针对特定国家的疾病传播采取措施的时机,是有助于短期及早控制当地大流行病的一个重要因素,也许比所实施的确切措施更重要。值得注意的是,这项研究仅限于最初的大流行应对。此外,它没有考虑到某些PHMs更广泛的长期影响,这应该是进一步研究的重点。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Timing, extent and outcomes of public health measures in the first wave of the COVID-19 pandemic in Israel and a comparative analysis by socioeconomic indices.

Timing, extent and outcomes of public health measures in the first wave of the COVID-19 pandemic in Israel and a comparative analysis by socioeconomic indices.

Timing, extent and outcomes of public health measures in the first wave of the COVID-19 pandemic in Israel and a comparative analysis by socioeconomic indices.

Timing, extent and outcomes of public health measures in the first wave of the COVID-19 pandemic in Israel and a comparative analysis by socioeconomic indices.

Background: Early in the coronavirus disease 2019 (COVID-19) pandemic, governments implemented exceptional public health measures (PHMs) in the face of uncertainty. This study aimed to compare mitigation policies implemented by Israel and their timing in the first wave of the pandemic to those of other countries, and to assess whether country characteristics such as democracy, trust, education, economic strength and healthcare reserve were associated with decision-making.

Methods: PHMs and pre-pandemic characteristics, using internationally accepted indices, of 50 countries were collected from 1/1/2020-30/06/2020; and associations between them were assessed. Time to implementation of these measures was compared among the Organisation for Economic Co-operation (OECD) nations. Log-rank test was used for univariate analysis. Cox regression was performed to assess the independent contribution of pre-pandemic characteristics to time-to-implementation of measures. Correlations between timing of specific measures and COVID-19 mortality at 60 days were assessed.

Results: Israel ranked in the upper third of the OECD in swiftness to implementation of eight of the ten measures compared. In univariate survival analysis, countries with an education level below the OECD median were more likely to implement a lockdown (p-value = 0.043) and to close restaurants and entertainment venues (p-value = 0.007) when compared to countries above the OECD median. In Cox regression models, controlling for geographic location, democracy level above the OECD median was associated with a longer time-to-implementation of a lockdown (HR=0.35, 95% CI=0.14-0.88, p-value=0.025). Similarly, a high level of GDP per capita was inversely associated with closing schools; and a high level of education inversely associated with closure of restaurants and entertainment venues. Earlier initiation of all PHMs was associated with lower mortality at 60 days, controlling for geographic location.

Conclusions: Israel's initial response to the pandemic was relatively quick, and may have been facilitated by its geographic isolation. Countries with lower pre-pandemic socio-economic indices were quicker to initiate forced social distancing. Early initiation of PHMs was associated with reduced mortality in the short run. Timing of initiation of measures relative to the country-specific spread of disease is a significant factor contributing to short-term early local pandemic control, perhaps more than the exact measures implemented. It is important to note that this study is limited to the initial pandemic response. Furthermore, it does not take into account the broader long-term effects of certain PHMs, which should be a focus of further research.

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来源期刊
CiteScore
6.20
自引率
4.40%
发文量
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审稿时长
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