Impact of Social Deprivation on Hospitalization and Intensive Care Unit Admission among COVID-19 Patients: A Systematic Review and Meta-Analysis

Yang-Jie  Zhu; Kang  Tang; Fang-Jie  Zhao; Bo-Yang  Yu; Tong-Tong  Liu; Lu-Lu  Zhang

doi:10.18502/ijph.v51i11.11163

Yang-Jie Zhu Department of Military Health Management, College of Health Service, Naval Medical University, Shanghai 200433, China
Kang Tang Department of Military Health Management, College of Health Service, Naval Medical University, Shanghai 200433, China
Fang-Jie Zhao Department of Military Health Management, College of Health Service, Naval Medical University, Shanghai 200433, China
Bo-Yang Yu Department of Military Health Management, College of Health Service, Naval Medical University, Shanghai 200433, China
Tong-Tong Liu Department of Military Health Management, College of Health Service, Naval Medical University, Shanghai 200433, China
Lu-Lu Zhang Department of Military Health Management, College of Health Service, Naval Medical University, Shanghai 200433, China

DOI: https://doi.org/10.18502/ijph.v51i11.11163

Keywords: COVID-19; Socioeconomic status; Social deprivation; Healthcare utilization; Meta-analysis

Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected socially disadvantaged groups; however, the association between socioeconomic status and healthcare utilization among COVID-19 patients remains unclear. Therefore, a systematic review and meta-analysis was conducted to assess the association between socioeconomic status and hospitalization and intensive care unit admission among COVID-19 patients.

Methods: PubMed, Embase, and the Cochrane Register of Controlled Trials were searched for relevant literature (updated to Jun 2022). Studies that investigated the association of social deprivation with hospitalization and intensive care unit admission in COVID-19 patients were included. The primary outcomes included risk of hospitalization and intensive care unit admission, measured by odds ratio.

Results: Eleven studies covering 2,423,095 patients were included in the meta-analysis. Socially disadvantaged patients had higher odds of hospitalization in comparison to socially advantaged patients (odds ratio 1.25, 95% confidence interval: 1.14 to 1.38; P<0.01). The odds of intensive care unit admission among more deprived patients was not significantly different from that of less deprived patients (odds ratio 1.03, 95% confidence interval: 0.78 to 1.35; P=0.85). These findings were proven robust through subgroup and sensitivity analyses.

Conclusion: Socially disadvantaged populations have higher odds of hospitalization if they become infected with COVID-19. More effective medical support and interventions for these vulnerable populations are required to reduce inequity in healthcare utilization and alleviate the burden on healthcare systems.