A systematic review of racial/ethnic and socioeconomic disparities in COVID-19

DOI

10.1186/s12939-021-01582-4

Authors

Ahmad Khanijahani, Department of Health Administration and Public Health, John G. Rangos School of Health Sciences, Duquesne University, Pittsburgh, PA, USA.
Shabnam Iezadi, Hospital Management Research Center, Iran University of Medical Sciences, Tehran, Iran. iezadi.sh@iums.ac.ir.
Kamal Gholipour, Social Determinants of Health Research Center, Department of Health Service Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.
Saber Azami-Aghdash, Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran.
Deniz Naghibi, Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.

Document Type

Journal Article

Publication Date

11-24-2021

Publication Title

International journal for equity in health

Volume

20

Issue

1

First Page

248

Keywords

COVID-19, Disparities, Ethnicity, Race, Socioeconomic status, Vulnerable population

Abstract

BACKGROUND: Preliminary evidence from the COVID-19 pandemic shows the presence of health disparities, especially in terms of morbidity and mortality. This study aimed to systematically review the evidence on the association of racial/ethnic and socioeconomic status (SES) with health outcomes and access to healthcare services during the COVID-19 pandemic. METHODS: We retrieved published evidence from late December 2019 through March 1, 2021. The target population was the population of the countries during the COVID-19 pandemic. The exposures were defined as belonging to racial/ethnic minority groups and/or low SES. The primary outcomes of interest include (1) death from COVID-19, (2) COVID-19 incidence/infection, (3) COVID-19 hospitalization, (4) ICU admission, (5) need for mechanical ventilation, (6) confirmed diagnosis, and (7) access to testing. We systematically synthesized the findings from different studies and provided a narrative explanation of the results. RESULTS: After removing the duplicate results and screening for relevant titles and abstracts, 77 studies were selected for full-text review. Finally, 52 studies were included in the review. The majority of the studies were from the United States (37 studies). Despite the significant incongruity among the studies, most of them showed that racial/ethnic minority groups had higher risks of COVID-19 infection and hospitalization, confirmed diagnosis, and death. Additionally, most of the studies cited factors such as low level of education, poverty, poor housing conditions, low household income, speaking in a language other than the national language in a country, and living in overcrowded households as risk factors of COVID-19 incidence/infection, death, and confirmed diagnosis. However, findings in terms of the association of lack of health insurance coverage and unemployment with the outcome measures as well as the association of requiring mechanical ventilation, ICU admission, and access to testing for COVID-19 with race/ethnicity were limited and inconsistent. CONCLUSION: It is evident that racial/ethnic minority groups and those from low SES are more vulnerable to COVID-19; therefore, public health policymakers, practitioners, and clinicians should be aware of these inequalities and strive to narrow the gap by focusing on vulnerable populations. This systematic review also revealed a major incongruity in the definition of the racial/ethnic minority groups and SES among the studies. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020190105.

Open Access

Gold

Repository Citation

Khanijahani, A., Iezadi, S., Gholipour, K., Azami-Aghdash, S., & Naghibi, D. (2021). A systematic review of racial/ethnic and socioeconomic disparities in COVID-19. International journal for equity in health, 20 (1), 248. https://doi.org/10.1186/s12939-021-01582-4