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Waves of inequality: income differences in intensive care due to Covid-19 in Sweden
Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.ORCID iD: 0000-0001-9349-9936
Department of Public Health Sciences, Stockholm University , Stockholm, Sweden;Aging Research Center (ARC), Karolinska Institutet , Solna, Sweden.ORCID iD: 0000-0002-7156-3260
Department of Public Health Sciences, Stockholm University , Stockholm, Sweden.
2023 (English)In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 33, no 4, p. 574-579Article in journal (Refereed) Published
Abstract [en]

Background: Socioeconomically vulnerable groups were overall more likely to develop severe Covid-19, but specific conditions in terms of preparedness, knowledge and the properties of the virus itself changed during the course of the pandemic. Inequalities in Covid-19 may therefore shift over time. This study examines the relationship between income and intensive care (ICU) episodes due to Covid-19 in Sweden during three distinct waves.

Methods: This study uses Swedish register data on the total adult population and estimates the relative risk (RR) of ICU episodes due to Covid-19 by income quartile for each month between March 2020 and May 2022, and for each wave, using Poisson regression analyses.

Results: The first wave had modest income-related inequalities, while the second wave had a clear income gradient, with the lowest income quartile having an increased risk compared to the high-income group [RR: 1.55 (1.36–1.77)]. In the third wave, the overall need for ICU decreased, but RRs increased, particularly in the lowest income quartile [RR: 3.72 (3.50–3.96)]. Inequalities in the third wave were partly explained by differential vaccination coverage by income quartile, although substantial inequalities remained after adjustment for vaccination status [RR: 2.39 (2.20–2.59)].

Conclusions: The study highlights the importance of considering the changing mechanisms that connect income and health during a novel pandemic. The finding that health inequalities increased as the aetiology of Covid-19 became better understood could be interpreted through the lens of adapted fundamental cause theory.

Place, publisher, year, edition, pages
2023. Vol. 33, no 4, p. 574-579
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:su:diva-220306DOI: 10.1093/eurpub/ckad094ISI: 001008428700001OAI: oai:DiVA.org:su-220306DiVA, id: diva2:1790413
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2022-00262Forte, Swedish Research Council for Health, Working Life and Welfare, 2022-00262Available from: 2023-08-22 Created: 2023-08-22 Last updated: 2023-08-31Bibliographically approved

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