Social determinants of mortality from COVID-19: A simulation study using NHANES.
Social determinants of mortality from COVID-19: A simulation study using NHANES.
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DOI：
10.1371/journal.pmed.1003490
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发表时间：
2021-01
期刊：
影响因子：
15.8
通讯作者：
Bloom DE
中科院分区：
文献类型：
--
作者：
Seligman B;Ferranna M;Bloom DE
COVID-19 在美国的流行十分广泛，截至 2020 年 9 月 23 日，报告死亡人数超过 200,000 人。虽然生态研究表明，贫困率较高的地区的 COVID-19 死亡率负担较高，但人们对个人层面上 COVID-19 死亡率的社会决定因素知之甚少。我们利用 2017-2018 年国家健康和营养检查调查 (NHANES) 报告的普通人群中 COVID-19 死亡的单变量比例以及这些变量之间的相关性，按年龄、性别、种族/族裔和合并症估计了 COVID-19 死亡的比例。我们使用这些比例从 NHANES 中随机抽取个体。我们按种族/民族、收入、教育水平和退伍军人身份分析了 COVID-19 死亡人数的分布。我们通过逻辑回归分析了这些特征与死亡率的关联。死亡人口统计概况包括平均年龄 71.6 岁、45.9% 为女性、45.1% 为非西班牙裔白人。我们发现，非白人种族/族裔的死亡比例过高（死亡人数的 54.8%，95% CI 49.0%–59.6%，p < 0.001）、收入低于中位数的个人（67.5%，95% CI 63.4%–71.5%，p < 0.001）、高中以下教育水平的个人（25.6%， 95% CI 23.4% –27.9%, p < 0.001) 和退伍军人 (19.5%, 95% CI 15.8%–23.4%, p < 0.001)。除退伍军人身份外，这些特征在多元 Logistic 回归中与 COVID-19 死亡率显着相关。局限性包括样本中缺乏机构化人群（例如疗养院居民和被监禁者）、需要使用从美国境外收集的合并症数据，以及假设非机构化人群和 COVID-19 死者的变量之间具有相同的相关性。 COVID-19 死亡率可能会出现严重不平等，少数族裔/族裔、贫困者、受教育程度较低的人和退伍军人将承受不成比例的负担。医疗保健系统必须确保这些群体有足够的机会获得服务。公共卫生措施应专门针对这些群体，并应系统地从 COVID-19 患者那里收集有关社会决定因素的数据。在这项模拟研究中，Benjamin Seligman 及其同事探讨了与美国 COVID-19 死亡相关的社会人口因素。研究发现，美国 (US) 的 COVID-19 疫情对少数种族/族裔和贫困程度较高的地区造成了不成比例的影响。除种族/民族外，关于个人层面健康社会决定因素的 COVID-19 死亡数据很少。我们使用 2017-2018 年国家健康和营养检查调查 (NHANES) 以及美国、中国、英国、西班牙、意大利和法国公共卫生机构公开报告的 COVID-19 死亡数据来模拟美国 20 岁或以上非机构化（例如，不住在监狱或疗养院）成年人中的 COVID-19 死亡情况。我们发现 COVID-19 死亡率存在很大的社会梯度。收入低于中位收入家庭的成年人占 COVID-19 死亡人数的三分之二，而高中教育程度以下的人约占死亡人数的四分之一。退伍军人也占死亡人数的近五分之一，尽管他们只占总人口的十分之一。我们的模拟再现了已知的 COVID-19 死亡率的种族/民族差异。健康的社会决定因素与 COVID-19 死亡率之间的关联程度与高血压和糖尿病与 COVID-19 死亡率之间的关联程度相似。缓解 COVID-19 需要采取措施支持低收入、低教育社区的人们以及为他们服务的医疗系统。
The COVID-19 epidemic in the United States is widespread, with more than 200,000 deaths reported as of September 23, 2020. While ecological studies show higher burdens of COVID-19 mortality in areas with higher rates of poverty, little is known about social determinants of COVID-19 mortality at the individual level. We estimated the proportions of COVID-19 deaths by age, sex, race/ethnicity, and comorbid conditions using their reported univariate proportions among COVID-19 deaths and correlations among these variables in the general population from the 2017–2018 National Health and Nutrition Examination Survey (NHANES). We used these proportions to randomly sample individuals from NHANES. We analyzed the distributions of COVID-19 deaths by race/ethnicity, income, education level, and veteran status. We analyzed the association of these characteristics with mortality by logistic regression. Summary demographics of deaths include mean age 71.6 years, 45.9% female, and 45.1% non-Hispanic white. We found that disproportionate deaths occurred among individuals with nonwhite race/ethnicity (54.8% of deaths, 95% CI 49.0%–59.6%, p < 0.001), individuals with income below the median (67.5%, 95% CI 63.4%–71.5%, p < 0.001), individuals with less than a high school level of education (25.6%, 95% CI 23.4% –27.9%, p < 0.001), and veterans (19.5%, 95% CI 15.8%–23.4%, p < 0.001). Except for veteran status, these characteristics are significantly associated with COVID-19 mortality in multiple logistic regression. Limitations include the lack of institutionalized people in the sample (e.g., nursing home residents and incarcerated persons), the need to use comorbidity data collected from outside the US, and the assumption of the same correlations among variables for the noninstitutionalized population and COVID-19 decedents. Substantial inequalities in COVID-19 mortality are likely, with disproportionate burdens falling on those who are of racial/ethnic minorities, are poor, have less education, and are veterans. Healthcare systems must ensure adequate access to these groups. Public health measures should specifically reach these groups, and data on social determinants should be systematically collected from people with COVID-19. In this simulation study, Benjamin Seligman and colleagues explore socio-demographic factors associated with COVID-19 deaths in the US. The COVID-19 epidemic in the United States of America (US) has been found to disproportionally affect racial/ethnic minorities and areas with higher concentrations of poverty. Few data on COVID-19 deaths with respect to individual-level social determinants of health other than race/ethnicity are available. We used the 2017–2018 National Health and Nutrition Examination Survey (NHANES) and publicly reported data on COVID-19 deaths from the public health agencies of the US, China, the United Kingdom, Spain, Italy, and France to simulate COVID-19 deaths among noninstitutionalized (e.g., not residing in a prison or nursing home) adults aged 20 years or older in the US. We found large social gradients in COVID-19 mortality. Adults from households earning less than the median income made up two-thirds of COVID-19 deaths, while those with less than a high school education accounted for approximately 1 in 4 deaths. Veterans also accounted for nearly 1 in 5 deaths, despite representing less than one-tenth of the population. Our simulation reproduced known racial/ethnic disparities in COVID-19 mortality. The associations between social determinants of health and COVID-19 mortality are similar in scale to those between hypertension and diabetes and COVID-19 mortality. COVID-19 mitigation will require measures to support people from low-income, low-education communities and the healthcare systems that serve them.
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DOI：
10.15585/mmwr.mm6915e3
发表时间：
2020-04-17
期刊：
MMWR. Morbidity and mortality weekly report
影响因子：
--
作者：
Garg S;Kim L;Whitaker M;O'Halloran A;Cummings C;Holstein R;Prill M;Chai SJ;Kirley PD;Alden NB;Kawasaki B;Yousey-Hindes K;Niccolai L;Anderson EJ;Openo KP;Weigel A;Monroe ML;Ryan P;Henderson J;Kim S;Como-Sabetti K;Lynfield R;Sosin D;Torres S;Muse A;Bennett NM;Billing L;Sutton M;West N;Schaffner W;Talbot HK;Aquino C;George A;Budd A;Brammer L;Langley G;Hall AJ;Fry A
通讯作者：
Fry A
影响因子：
24.3
作者：
Guan, Wei-jie;Liang, Wen-hua;He, Jian-xing
通讯作者：
He, Jian-xing
影响因子：
4.5
作者：
Agabiti N;Pirani M;Schifano P;Cesaroni G;Davoli M;Bisanti L;Caranci N;Costa G;Forastiere F;Marinacci C;Russo A;Spadea T;Perucci CA;Italian Study Group on Inequalities in Health Care
通讯作者：
Italian Study Group on Inequalities in Health Care
影响因子：
3.8
作者：
Ferrari, Pier Alda;Barbiero, Alessandro
通讯作者：
Barbiero, Alessandro
影响因子：
3.8
作者：
Fallah, Mosoka P.;Skrip, Laura A.;Galvani, Alison P.
通讯作者：
Galvani, Alison P.