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Educational status and COVID-19 related outcomes in India: hospital-based cross-sectional study
Arvind K Sharma1, Rajeev Gupta2,3, Vaseem Naheed Baig1
1Department of Community Medicine, RUHS College of Medical Sciences, Jaipur, India.
Insights
Lower educational attainment in COVID-19 patients correlates with worse hospital outcomes and increased mortality. This study highlights educational status as a key social determinant impacting severe COVID-19 results in India.
Area of Science:
- Public Health
- Epidemiology
- Socioeconomic Determinants of Health
Background:
- The association between educational status and COVID-19 outcomes remains under-researched.
- Educational attainment serves as a proxy for socioeconomic status, influencing health disparities.
Purpose of the Study:
- To investigate the relationship between educational status and in-hospital outcomes among COVID-19 patients.
- To determine if lower educational attainment is associated with increased adverse events and mortality in COVID-19.
Main Methods:
- A hospital-based cross-sectional study was conducted with 4645 COVID-19 patients.
- Patients were categorized into three groups based on educational status: illiterate/≤primary, higher secondary, and some college.
- Logistic regression analysis was used to compare outcomes between groups.
Main Results:
- Patients with lower educational status (illiterate or ≤primary) exhibited higher rates of tobacco use, hypoxia, lymphocytopenia, and organ dysfunction.
- Significantly greater requirements for oxygen support, non-invasive ventilation, and invasive ventilation were observed in the lowest education group.
- The lowest education group had a higher mortality rate (10.0%) compared to higher education groups (6.8% and 5.5%), with adjusted odds ratios indicating increased mortality risk.
Conclusions:
- Lower educational status is significantly associated with adverse in-hospital outcomes and increased mortality in COVID-19 patients in India.
- Educational attainment is a critical factor influencing COVID-19 severity and survival.
- Findings underscore the need to address socioeconomic disparities in public health strategies for infectious diseases.
Objective:
Association of educational status, as marker of socioeconomic status, with COVID-19 outcomes has not been well studied. We performed a hospital-based cross-sectional study to determine its association with outcomes.
Methods:
Successive patients of COVID-19 presenting at government hospital were recruited. Demographic and clinical details were obtained at admission, and in-hospital outcomes were assessed. Cohort was classified according to self-reported educational status into group 1: illiterate or ≤primary; group 2: higher secondary; and group 3: some college. To compare intergroup outcomes, we performed logistic regression.
Results:
4645 patients (men 3386, women 1259) with confirmed COVID-19 were recruited. Mean age was 46±18 years, most lived in large households and 30.5% had low educational status. Smoking or tobacco use was in 29.5%, comorbidities in 28.6% and low oxygen concentration (SpO2 <95%) at admission in 30%. Average length of hospital stay was 6.8±3.7 days, supplemental oxygen was provided in 18.4%, high flow oxygen or non-invasive ventilation 7.1% and mechanical ventilation 3.6%, 340 patients (7.3%) died. Group 1 patients had more tobacco use, hypoxia at admission, lymphocytopaenia, and liver and kidney dysfunction. In group 1 versus groups 2 and 3, requirement of oxygen (21.6% vs 16.7% and 17.0%), non-invasive ventilation (8.0% vs 5.9% and 7.1%), invasive ventilation (4.6% vs 3.5% and 3.1%) and deaths (10.0% vs 6.8% and 5.5%) were significantly greater (p<0.05). OR for deaths were higher in group 1 (1.91, 95% CI 1.46 to 2.51) and group 2 (1.24, 95% CI 0.93 to 1.66) compared with group 3. Adjustment for demographic and comorbidities led to some attenuation in groups 1 (1.44, 95% CI 1.07 to 1.93) and 2 (1.38, 95% CI 1.02 to 1.85); this persisted with adjustments for clinical parameters and oxygen support in groups 1 (1.38, 95% CI 0.99 to 1.93) and 2 (1.52, 95% CI 1.01 to 2.11).
Conclusion:
Low educational status patients with COVID-19 in India have significantly greater adverse in-hospital outcomes and mortality.
Trial Registration Number:
REF/2020/06/034036.
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