How Inequities and Disparities in Health & Healthcare Are Impacting COVID-19 Outcomes: A Scoping Review
Author(s)
Craig K1, Bright TJ2, Karunakaram H3, VanHouten C2, Akdas Y4, Dankwa-Mullan I2
1IBM Watson Health, Centennial, CO, USA, 2IBM Watson Health, Cambridge, MA, USA, 3CVS Health, Woonsocket, RI, USA, 4Vanderbilt University Medical Center, Nashville, TN, USA
OBJECTIVES:
The COVID-19 pandemic exacerbated disparities in socially disadvantaged or underprivileged populations. The objective was to identify and synthesize studies reporting inequities among health disparity groups or vulnerable populations by assessing COVID-19-related health and healthcare outcomes.METHODS:
A scoping review was conducted to identify articles from MEDLINE, Embase, Cochrane Library, and CINAHL databases. The study population included racial/ethnic minority groups, sexual and gender minorities, the disabled, low socioeconomic status (SES) including the urban or rural poor, the homeless, refugees, and the incarcerated. COVID-19 related outcomes included health (e.g., mortality, hospitalization, length of stay, intensive care unit (ICU) admission, invasive mechanical ventilation) and healthcare (e.g., structural barriers to prevention, COVID-19 exposure, testing, non-pharmaceutical interventions (NPIs), treatment). Inclusion criteria required the study to report disparities or inequities in the outcomes of interest among the study population in US COVID-19 settings.RESULTS:
Literature searches identified 1,282 citations and 145 studies met inclusion criteria. The primary populations identified were racial/ethnic minorities (number of studies, 98), low SES (44) with urban or rural geography (32), gender (9), disabled (8), homeless (7), incarcerated (3), and refugees (3). Of these, vulnerable subgroups included the ill or immunocompromised (61), elderly (32), children (9), pregnant women (5), and malnourished people (5). Disparities in health (97) were more frequently identified than healthcare (68). Disproportionate negative health outcomes identified included mortality (76), hospitalization (48), invasive mechanical ventilation (27), and ICU admission (25). Healthcare inequalities were observed as increased exposure to disease (42), decreased testing (27), increased structural barriers to prevention (18), and lower NPI adherence (11).CONCLUSIONS:
This disproportionate burden of outcomes may reflect the patterns of unique exposure and transmission pathways, level of knowledge and access to reliable information about the disease, and access to and receipt of care in these populations.Conference/Value in Health Info
2022-05, ISPOR 2022, Washington, DC, USA
Value in Health, Volume 25, Issue 6, S1 (June 2022)
Code
HPR55
Topic
Clinical Outcomes, Epidemiology & Public Health, Health Policy & Regulatory, Study Approaches
Topic Subcategory
Clinical Outcomes Assessment, Health Disparities & Equity, Literature Review & Synthesis, Public Health
Disease
No Additional Disease & Conditions/Specialized Treatment Areas