Swiss study suggests low-income people had worse COVID-19 outcomes

TORONTO -

A new Swiss study suggests that people in low-income neighbourhoods are less likely to get tested for COVID-19, but more likely to have contracted the virus, become hospitalized and die from complications associated with the disease.

The research, presented at this year's European Congress of Clinical Microbiology & Infectious Diseases (ECCMID) and to be published in The Lancet Public Health, analyzed data from the Swiss Federal Office of Public Health from March 1, 2020, to April 16, 2021.

Researchers assigned a rating to the households involved in the study using the Swiss neighbourhood index of socioeconomic position. The index ranks 1.27 million small neighbourhoods by rent per square metre, education and occupation of heads of the household. Each household is ranked from one (poorest) to 10 (wealthiest).

The researchers analyzed more than 4.1 million COVID-19 tests, including more than 600,000 positive tests, 26,143 hospital admissions, 2432 ICU admissions, 9383 deaths, and 8,221,406 residents.

The researchers found that people in the wealthiest neighbourhoods were 18 per cent more likely to have been tested for COVID-19, and 25 per cent less likely to test positive than those in low-income neighbourhoods.

In addition, the data showed that people from higher income neighbourhoods were 32 per cent less likely to be hospitalized, 46 per cent less likely to end up in the ICU and 14 per cent less likely to die from the disease.

"In this whole-population study of the COVID-19 epidemic in Switzerland in 2020-21, we found that people living in wealthier areas were more likely to get tested for SARS-CoV-2 but less likely to test positive and be admitted to hospital or the ICU, and less likely to die, compared with those in poorer areas,” the study authors said in a press release.

The researchers emphasized that this study illustrates the “inverse care law,” despite Switzerland being one of the world’s wealthiest countries. The principle, proposed by Julian Tudor Hart in The Lancet in 1971, states that low-income people require more healthcare than higher-income people but in reality, receive less.

They said that the higher rates of infection combined with more frequent comorbidities in lower-income neighbourhoods compared with wealthy neighbourhoods likely contributed to the worse outcomes.

“Governments and health-care systems should address this pandemic of inequality by taking measures to reduce health inequalities in their response to the SARS-CoV-2 pandemic."