Waves of Inequality: Income Differences in Intensive Care Due to Covid-19 in Sweden

Overview

Journal Eur J Public Health

Publisher Oxford University Press

Specialty Public Health

Date 2023 Jun 15

PMID 37322545

Authors

Karl Gauffin

Olof Ostergren

Agneta Cederstrom

Affiliations

Soon will be listed here.

Abstract

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.

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