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Published on: June 29, 2021
Health disparities in complicated lower respiratory tract infections: a population-based cohort study in The Hague,
Ernst D van Dokkum1, Martijn Sijbom1, Saskia le Cessie2
1Department of Public Health and Primary Care, Health Campus The Hague, Leiden University Medical Center, Leiden, The Netherlands.
Introduction:
International studies show that ethnic minority groups and individuals with lower socioeconomic status (SES) face higher severity of lower respiratory tract infections (LRTIs). It is unclear whether these associations exist in the Netherlands and to what extent they are mediated through comorbidities and household composition. Our study investigates the relationship between sociodemographic factors and complicated LRTI before and during the COVID-19 pandemic in The Hague, the Netherlands.
Methods:
A population-based cohort study was conducted using sociodemographic and insurance claims data from Statistics Netherlands, covering The Hague's adult population in 2014-2019 (pre-COVID-19) and 2020 (COVID-19). The associations of structural determinants (age, sex, SES, migration background) and intermediary determinants (comorbidities, household composition) on complicated LRTI incidence and mortality were assessed using Poisson regression models. Complicated LRTI episodes were defined as hospital admission or death within 14 days after an emergency department visit.
Results:
In 2014-2019, individuals in the lowest SES quintile displayed the highest incidence of complicated LRTI (adjusted incidence rate ratio (aIRR) 2.26 (95% CI 1.98 to 2.57)), and LRTI-associated mortality (aIRR 3.49 (95% CI 2.28 to 5.34)), compared with the highest SES quintile, after adjusting for structural and intermediary determinants. Similar associations were observed in 2020 with those in the lowest SES quintile displaying the highest complicated LRTI incidence (aIRR 1.47 (95% CI 1.21 to 1.77)). Individuals without a migration background were most affected in 2014-2019, while individuals with a migration background were more impacted in 2020. Individuals with a Moroccan (aIRR 3.19 (95% CI 2.63 to 3.89)) or Turkish (aIRR 2.83 (95% CI 2.35 to 3.40)) background showed the highest complicated LRTI incidence rates in 2020.
Conclusions:
Lower SES was consistently associated with a higher incidence of complicated LRTI. Populations with a migration background were particularly vulnerable during the pandemic. These findings underscore the need to consider SES and migration background in targeted treatment, prevention and population health strategies.
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