Socioeconomic inequalities in pandemic-induced psychosocial stress in different life domains among the working-age population.

BACKGROUND: Psychosocial stress is considered a risk factor for physical and mental ill-health. Evidence on socioeconomic inequalities with regard to the psychosocial consequences of the COVID-19 pandemic in Germany is still limited. We aimed to investigate how pandemic-induced psychosocial stress (PIPS) in different life domains differed between socioeconomic groups. METHODS: Data came from the German Corona-Monitoring nationwide study - wave 2 (RKI-SOEP-2, November 2021-February 2022). PIPS was assessed using 4-point Likert scales with reference to the following life domains: family, partnership, own financial situation, psychological well-being, leisure activity, social life and work/school situation. Responses were dichotomised into "not stressed/slightly stressed/rather stressed" (0) versus "highly stressed" (1). The sample was restricted to the working-age population in Germany (age = 18-67 years, n = 8,402). Prevalence estimates of high PIPS were calculated by sex, age, education and income. Adjusted prevalence ratios (PRs) were estimated using Poisson regression to investigate the association between education/income and PIPS; high education and income were the reference groups. RESULTS: The highest stress levels were reported in the domains social life and leisure activity. Women and younger participants reported high stress levels more frequently. The highest inequalities were found regarding people's own financial situation, and PIPS was higher in low vs. high income groups (PR 5.54, 95% CI 3.61-8.52). Inequalities were also found regarding partnerships with higher PIPS in low vs. high education groups (PR 1.68, 95% CI 1.13-2.49) - and psychological well-being with higher PIPS in low vs. high income groups (PR 1.52, 95% CI 1.14-2.04). CONCLUSION: Socioeconomic inequalities in PIPS were found for different life domains. Generally, psychosocial support and preventive interventions to help people cope with stress in a pandemic context should be target-group-specific, addressing the particular needs and circumstances of certain socioeconomic groups.

[Subjective health in the early phase of the COVID-19 pandemic-a comparison of socio-demographic groups and pandemic-related risk factors]. / Subjektive Gesundheit in der Frühphase der COVID-19-Pandemie ­ ein Vergleich von soziodemografischen Gruppen und pandemiebezogenen Risikofaktoren.

BACKGROUND: In the early stages of the COVID-19 pandemic in 2020, daily life was significantly restricted due to the containment measures of the initial lockdown while SARS-CoV­2 incidences remained relatively low. This study analyses socio-demographic and socio-economic groups in terms of changes in their subjective health during this phase. METHODS: Data from the Socio-Economic Panel (n = 14,856, March-July 2020) were used to estimate the relative frequency of self-reported good health, great worries about one's own health, and high life satisfaction of men and women stratified by age, education, income, migration history, pre-existing medical conditions, and high-risk occupation. The results were mutually adjusted using logistic regression, displayed on a monthly basis, and compared with the pre-pandemic period. RESULTS: Individuals of higher age, with lower education or income, and with pre-existing medical conditions reported positive health outcomes less frequently and worries more often. The differences between the subgroups remained largely stable compared to the pre-pandemic period. During the period of strongest restrictions due to infection-control measures, good health was reported less frequently by individuals with lower education or income compared to individuals with higher education or income. DISCUSSION: The impact of the early phase of the pandemic on subjective health and life satisfaction was low for the majority of the examined groups. Relative impairments were only identified for women in low socio-economic positions.

Socioeconomic differences in the reduction of face-to-face contacts in the first wave of the COVID-19 pandemic in Germany.

BACKGROUND: The COVID-19 pandemic has led to physical distancing measures to control the spread of SARS-CoV-2. Evidence on contact dynamics in different socioeconomic groups is still sparse. This study aimed to investigate the association of socioeconomic status with private and professional contact reductions in the first COVID-19 wave in Germany. METHODS: Data from two especially affected municipalities were derived from the population-based cross-sectional seroepidemiological CORONA-MONITORING lokal study (data collection May-July 2020). The study sample (n = 3,637) was restricted to working age (18-67 years). We calculated the association of educational and occupational status (low, medium, high) with self-reported private and professional contact reductions with respect to former contact levels in the first wave of the pandemic. Multivariate Poisson regressions were performed to estimate prevalence ratios (PR) adjusted for municipality, age, gender, country of birth, household size, contact levels before physical distancing measures, own infection status, contact to SARS-CoV-2 infected people and working remotely. RESULTS: The analyses showed significant differences in the initial level of private and professional contacts by educational and occupational status. Less private contact reductions with lower educational status (PR low vs. high = 0,79 [CI = 0.68-0.91], p = 0.002; PR medium vs. high = 0,93 [CI = 0.89-0.97], p = 0.001) and less professional contact reductions with lower educational status (PR low vs. high = 0,87 [CI = 0.70-1.07], p = 0.179; PR medium vs. high = 0,89 [CI = 0.83-0.95], p = 0.001) and lower occupational status (PR low vs. high = 0,62 [CI = 0.55-0.71], p < 0.001; PR medium vs. high = 0,82 [CI = 0.77-0.88], p < 0.001) were observed. CONCLUSIONS: Our results indicate disadvantages for groups with lower socioeconomic status in private and professional contact reductions in the first wave of the pandemic. This may be associated with the higher risk of infection among individuals in lower socioeconomic groups. Preventive measures that a) adequately explain the importance of contact restrictions with respect to varying living and working conditions and b) facilitate the implementation of these reductions especially in the occupational setting seem necessary to better protect structurally disadvantaged groups during epidemics.

Social Inequalities in Long-Term Health Effects After COVID-19-A Scoping Review.

Objectives: We aimed to map and synthesize evidence about social inequalities in long-term health effects after COVID-19 (LTHE), often referred to as "long COVID" or "post-COVID-19 conditions." Methods: We conducted a scoping review of peer-reviewed articles by searching the databases Embase and Scopus. According to predefined inclusion criteria, titles/abstracts and full texts were screened for eligibility. Additionally, reference lists of all included studies were hand-searched for eligible studies. This study followed the PRISMA guidelines for scoping reviews. Results: Nineteen articles were included. LTHE were analysed according to ethnicity, education, income, employment and deprivation indices. The studies varied significantly in their definitions of LTHE. Eighty-two analyses showed no statistically significant associations. At least 12 studies had a high risk of type II errors. Only studies associating deprivation indices and long COVID tended to show a higher prevalence of LTHE in deprived areas. Conclusion: Although some studies indicated social inequalities in LTHE, evidence was generally weak and inconclusive. Further studies with larger sample sizes specifically designed to detect social inequalities regarding LTHE are needed to inform future healthcare planning and public health policies.

Temporal dynamics of socioeconomic inequalities in depressive and anxiety symptoms during the COVID-19 pandemic: a scoping review.

Background: The existence of socioeconomic inequalities in the prevalence of symptoms of depression and anxiety is widely acknowledged, and individuals from lower socioeconomic backgrounds tend to exhibit higher rates of symptoms. However, the direction in which the COVID-19 pandemic has influenced these disparities remains uncertain. We therefore aimed to systematically outline the available evidence on the temporal dynamics of socioeconomic inequalities in symptoms related to depression and anxiety during the COVID-19 pandemic across high-income countries. Methods: A scoping review was conducted by searching the databases Embase, Scopus and PsycINFO. According to pre-defined eligibility criteria, two reviewers independently screened titles and abstracts as well as full texts of the compiled records. Data from the included studies were extracted using a standardised data-extraction form and analysed numerically and narratively. The scoping review followed the PRISMA-ScR guidelines. Results: A total of 49 studies comprising 149 analyses of socioeconomic indicators in relation to symptoms of depression and anxiety were included. Despite heterogeneous study designs and results, there was a tendency of increasing (40.9%; n = 61) or persistent (38.2%; n = 57) inequality trends to the detriment of those in socially more disadvantaged positions. Increasing inequalities were most pronounced when income was used as a socioeconomic indicator. Groups with lower socioeconomic status appeared most vulnerable in the initial phase of the COVID-19 pandemic. Throughout the pandemic, dynamics were diverse, with persistent trends most frequently reported. Conclusion: Overall, to the detriment of those with lower socioeconomic status, mental-health inequalities persisted or increased in most analyses. Continually monitoring socioeconomic inequalities over time is crucial, since this makes it possible to adapt prevention and intervention strategies to specific pandemic phases. Interventions targeting job security, income security and educational attainment could reduce mental-health inequalities. The results can contribute to preparedness plans for future pandemics and crises.

Education and pandemic SARS-CoV-2 infections in the German working population - the mediating role of working from home.

OBJECTIVES: SARS-CoV-2 infections were unequally distributed during the pandemic, with those in disadvantaged socioeconomic positions being at higher risk. Little is known about the underlying mechanism of this association. This study assessed to what extent educational differences in SARS-CoV-2 infections were mediated by working from home. METHODS: We used data of the German working population derived from the seroepidemiological study "Corona Monitoring Nationwide - Wave 2 (RKI-SOEP-2)" (N=6826). Infections were assessed by seropositivity against SARS-CoV-2 antigens and self-reports of previous PCR-confirmed infections from the beginning of the pandemic until study participation (November 2021 - February 2022). The frequency of working from home was assessed between May 2021 and January 2022.We used the Karlson-Holm-Breen (KHB) method to decompose the effect of education on SARS-CoV-2 infections. RESULTS: Individuals with lower educational attainment had a higher risk for SARS-CoV-2 infection (adjusted prevalence ratio of low versus very high = 1.76, 95% confidence interval 1.08-2.88; P=0.023). Depending on the level of education, between 27% (high education) and 58% (low education) of the differences in infection were mediated by the frequency of working from home. CONCLUSIONS: Working from home could prevent SARS-CoV-2 infections and contribute to the explanation of socioeconomic inequalities in infection risks. Wherever possible, additional capacities to work remotely, particularly for occupations that require lower educational attainment, should be considered as an important measure of pandemic preparedness. Limitations of this study are the observational cross-sectional design and that the temporal order between infection and working from home remained unclear.

Socioeconomic Differences in SARS-CoV-2 Infection and Vaccination in Germany: A Seroepidemiological Study After One Year of COVID-19 Vaccination Campaign.

Objective: To evaluate the socioeconomic patterns of SARS-CoV-2 antigen contacts through infection, vaccination or both ("hybrid immunity") after 1 year of vaccination campaign. Methods: Data were derived from the German seroepidemiological Corona Monitoring Nationwide study (RKI-SOEP-2; n = 10,448; November 2021-February 2022). Combining serological and self-report data, we estimated adjusted prevalence ratios (PR) of SARS-CoV-2 infection, COVID-19 vaccination, basic immunization (at least two SARS-CoV-2 antigen contacts through vaccination and/or infection), and three antigen contacts by education and income. Results: Low-education groups had 1.35-times (95% CI 1.01-1.82) the risk of SARS-CoV-2 infection compared to high-education groups. COVID-19 vaccination (at least one dose) and basic immunization decreased with lower education and income. Low-education and low-income groups were less likely to have had at least three antigen contacts (PR low vs. high education: 0.74, 95% CI 0.65-0.84; PR low vs. high income: 0.66, 95% CI 0.57-0.77). Conclusion: The results suggest a lower level of protection against severe COVID-19 for individuals from low and medium socioeconomic groups. Pandemic response and vaccination campaigns should address the specific needs and barriers of these groups.

Temporal Dynamics of Socioeconomic Inequalities in COVID-19 Outcomes Over the Course of the Pandemic-A Scoping Review.

Objectives: International evidence of socioeconomic inequalities in COVID-19 outcomes is extensive and growing, but less is known about the temporal dynamics of these inequalities over the course of the pandemic. Methods: We systematically searched the Embase and Scopus databases. Additionally, several relevant journals and the reference lists of all included articles were hand-searched. This study follows the PRISMA guidelines for scoping reviews. Results: Forty-six studies were included. Of all analyses, 91.4% showed stable or increasing socioeconomic inequalities in COVID-19 outcomes over the course of the pandemic, with socioeconomically disadvantaged populations being most affected. Furthermore, the study results showed temporal dynamics in socioeconomic inequalities in COVID-19, frequently initiated through higher COVID-19 incidence and mortality rates in better-off populations and subsequent crossover dynamics to higher rates in socioeconomically disadvantaged populations (41.9% of all analyses). Conclusion: The identified temporal dynamics of socioeconomic inequalities in COVID-19 outcomes have relevant public health implications. Socioeconomic inequalities should be monitored over time to enable the adaption of prevention and interventions according to the social particularities of specific pandemic phases.