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The mediating role of SARS-CoV-2 variants between income and hospitalisation due to COVID-19: A period-based mediation analysis.
Harrigan, Sean P; Fibke, Chad D; Velásquez García, Héctor A; Mak, Sunny; Wilton, James; Prystajecky, Natalie; Tyson, John; Wang, Linwei; Sander, Beate; Baral, Stefan; Mishra, Sharmistha; Janjua, Naveed Z; Sbihi, Hind.
Affiliation
  • Harrigan SP; British Columbia Centre for Disease Control, British Columbia (BC), Canada.
  • Fibke CD; University of British Columbia Centre for Disease Control, BC, Canada.
  • Velásquez García HA; British Columbia Centre for Disease Control, British Columbia (BC), Canada.
  • Mak S; University of British Columbia Centre for Disease Control, BC, Canada.
  • Wilton J; British Columbia Centre for Disease Control, British Columbia (BC), Canada.
  • Prystajecky N; University of British Columbia School of Population and Public Health, BC, Canada.
  • Tyson J; British Columbia Centre for Disease Control, British Columbia (BC), Canada.
  • Wang L; British Columbia Centre for Disease Control, British Columbia (BC), Canada.
  • Sander B; British Columbia Centre for Disease Control, British Columbia (BC), Canada.
  • Baral S; University of British Columbia Pathology and Laboratory Medicine, BC, Canada.
  • Mishra S; British Columbia Centre for Disease Control, British Columbia (BC), Canada.
  • Janjua NZ; University of British Columbia Pathology and Laboratory Medicine, BC, Canada.
  • Sbihi H; MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute Unity Health Toronto, Toronto, Canada.
Am J Epidemiol ; 2024 Aug 08.
Article in En | MEDLINE | ID: mdl-39117572
ABSTRACT
The mechanisms facilitating the relationship between low income and COVID-19 severity have not been partitioned in the presence of SARS-CoV-2 variants of concern (VOC). To address this, we used causal mediation analysis to quantify the possible mediating role infection with VOC has on the relationship between neighbourhood income (exposure) and hospitalisation due to COVID-19 among cases (outcome). A population-based cohort of 65,629 individuals residing in British Columbia, Canada, was divided into three periods of VOC co-circulation in the 2021 calendar year whereby each period included co-circulation of an emerging and an established VOC. Each cohort was subjected to g-formula mediation techniques to decompose the relationship between exposure and outcome into total, direct and indirect effects. In the mediation analysis, the total effects indicated that low income was associated with increased odds of hospitalisation across all periods. Further decomposition of the effects revealed that income is directly and indirectly associated with hospitalisation. The resulting indirect effect through VOC accounted for approximately between 6 and 13% of the total effect of income on hospitalisation. This study underscores, conditional on the analysis, the importance of addressing underlying inequities to mitigate the disproportionate impact on historically marginalised communities by adopting an equity lens as central to pandemic preparedness and response from the onset.
Key words

Full text: 1 Collection: 01-internacional Database: MEDLINE Language: En Journal: Am J Epidemiol Year: 2024 Document type: Article Affiliation country: Canadá Country of publication: Estados Unidos

Full text: 1 Collection: 01-internacional Database: MEDLINE Language: En Journal: Am J Epidemiol Year: 2024 Document type: Article Affiliation country: Canadá Country of publication: Estados Unidos