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Impacts of economic inequality on healthcare worker safety at the onset of the COVID-19 pandemic: cross-sectional analysis of a global survey.
Harrigan, Sean P; Tsang, Vivian W L; Yassi, Annalee; Zungu, Muzimkhulu; Spiegel, Jerry M.
Afiliación
  • Harrigan SP; Global Health Research Program, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada.
  • Tsang VWL; Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.
  • Yassi A; Global Health Research Program, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada.
  • Zungu M; National Institute for Occupational Health, Johannesburg, Gauteng, South Africa.
  • Spiegel JM; School of Health Systems and Public Health, University of Pretoria Faculty of Health Sciences, Pretoria, Gauteng, South Africa.
BMJ Open ; 12(10): e064804, 2022 10 05.
Article en En | MEDLINE | ID: mdl-36198468
ABSTRACT

OBJECTIVES:

To assess the extent to which protection of healthcare workers (HCWs) as COVID-19 emerged was associated with economic inequality among and within countries.

DESIGN:

Cross-sectional analysis of associations of perceptions of workplace risk acceptability and mitigation measure adequacy with indicators of respondents' respective country's economic income level (World Bank assessment) and degree of within-country inequality (Gini index).

SETTING:

A global self-administered online survey.

PARTICIPANTS:

4977 HCWs and healthcare delivery stakeholders from 161 countries responded to health and safety risk questions and a subset of 4076 (81.2%) answered mitigation measure questions. The majority (65%) of study participants were female.

RESULTS:

While the levels of risk being experienced at the pandemic's onset were consistently deemed as unacceptable across all groupings, participants from countries with less income inequality were somewhat less likely to report unacceptable levels of risk to HCWs regarding both workplace environment (OR=0.92, p=0.012) and workplace organisational factors (OR=0.93, p=0.017) compared with counterparts in more unequal national settings. In contrast, considerable variation existed in the degree to which mitigation measures were considered adequate. Adjusting for other influences through a logistic regression analysis, respondents from lower middle-income and low-income countries were comparatively much more likely to assess both occupational health and safety (OR=10.91, p≤0.001) and infection prevention and control (IPC) (OR=6.61, p=0.001) protection measures as inadequate, despite much higher COVID-19 rates in wealthier countries at the time of the survey. Greater within-country income inequality was also associated with perceptions of less adequate IPC measures (OR=0.94, p=0.025). These associations remained significant when accounting for country-level differences in occupational and gender composition of respondents, including specifically when only female care providers, our study's largest and most at-risk subpopulation, were examined.

CONCLUSIONS:

Economic inequality threatens resilience of health systems that rely on health workers working safely to provide needed care during emerging pandemics.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Contexto en salud: 1_ASSA2030 / 2_ODS3 / 4_TD Problema de salud: 1_acesso_equitativo_servicos / 1_doencas_nao_transmissiveis / 2_muertes_prematuras_enfermedades_notrasmisibles / 4_pneumonia Asunto principal: COVID-19 Tipo de estudio: Health_economic_evaluation / Observational_studies / Prevalence_studies / Risk_factors_studies Límite: Female / Humans / Male Idioma: En Revista: BMJ Open Año: 2022 Tipo del documento: Article País de afiliación: Canadá

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Contexto en salud: 1_ASSA2030 / 2_ODS3 / 4_TD Problema de salud: 1_acesso_equitativo_servicos / 1_doencas_nao_transmissiveis / 2_muertes_prematuras_enfermedades_notrasmisibles / 4_pneumonia Asunto principal: COVID-19 Tipo de estudio: Health_economic_evaluation / Observational_studies / Prevalence_studies / Risk_factors_studies Límite: Female / Humans / Male Idioma: En Revista: BMJ Open Año: 2022 Tipo del documento: Article País de afiliación: Canadá
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