Waves of inequality: income differences in intensive care due to Covid-19 in Sweden.

Gauffin K, Östergren O, Cederström A

Eur J Public Health 33 (4) 574-579 [2023-08-01; online 2023-06-16]

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. 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. 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)]. 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.

Category: Public Health

Category: Social Science & Humanities

Funder: Forte

Type: Journal article

PubMed 37322545

DOI 10.1093/eurpub/ckad094

Crossref 10.1093/eurpub/ckad094

pmc: PMC10393505
pii: 7199199

Publications 9.5.0