Differential Impacts of Multimorbidity on COVID-19 Severity across the Socioeconomic Ladder in Hong Kong: A Syndemic Perspective
The severity of COVID-19 infections could be exacerbated by the epidemic of chronic diseases and underlying inequalities in social determinants of health. Nonetheless, there is scanty evidence in regions with a relatively well-controlled outbreak. This study examined the socioeconomic patterning of...
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| Veröffentlicht in: | International journal of environmental research and public health 2021-08, Vol.18 (15), p.8168 |
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| creator | Chung, Gary Ka-Ki Chan, Siu-Ming Chan, Yat-Hang Yip, Terry Cheuk-Fung Ma, Hon-Ming Wong, Grace Lai-Hung Chung, Roger Yat-Nork Wong, Hung Wong, Samuel Yeung-Shan Yeoh, Eng Kiong Marmot, Michael Woo, Jean |
| description | The severity of COVID-19 infections could be exacerbated by the epidemic of chronic diseases and underlying inequalities in social determinants of health. Nonetheless, there is scanty evidence in regions with a relatively well-controlled outbreak. This study examined the socioeconomic patterning of COVID-19 severity and its effect modification with multimorbidity in Hong Kong. 3074 local COVID-19 cases diagnosed from 5 July to 31 October 2020 were analyzed and followed up until 30 November 2020. Data on residential addresses, socio-demographic background, COVID-19 clinical conditions, and pre-existing chronic diseases of confirmed cases were retrieved from the Centre for Health Protection and the Hospital Authority. Results showed that, despite an independent adverse impact of multimorbidity on COVID-19 severity (aOR = 2.35 [95% CI = 1.72-3.19]), it varied across the socioeconomic ladder, with no significant risk among those living in the wealthiest areas (aOR = 0.80 [0.32-2.02]). Also, no significant association of the area-level income-poverty rate with severe COVID-19 was observed. In conclusion, the socioeconomic patterning of severe COVID-19 was mild in Hong Kong. Nonetheless, socioeconomic position interacted with multimorbidity to determine COVID-19 severity with a mitigated risk among the socioeconomically advantaged. Plausible explanations include the underlying socioeconomic inequalities in chronic disease management and the equity impact of the public-private dual-track healthcare system. |
| doi_str_mv | 10.3390/ijerph18158168 |
| format | Article |
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Nonetheless, there is scanty evidence in regions with a relatively well-controlled outbreak. This study examined the socioeconomic patterning of COVID-19 severity and its effect modification with multimorbidity in Hong Kong. 3074 local COVID-19 cases diagnosed from 5 July to 31 October 2020 were analyzed and followed up until 30 November 2020. Data on residential addresses, socio-demographic background, COVID-19 clinical conditions, and pre-existing chronic diseases of confirmed cases were retrieved from the Centre for Health Protection and the Hospital Authority. Results showed that, despite an independent adverse impact of multimorbidity on COVID-19 severity (aOR = 2.35 [95% CI = 1.72-3.19]), it varied across the socioeconomic ladder, with no significant risk among those living in the wealthiest areas (aOR = 0.80 [0.32-2.02]). Also, no significant association of the area-level income-poverty rate with severe COVID-19 was observed. In conclusion, the socioeconomic patterning of severe COVID-19 was mild in Hong Kong. Nonetheless, socioeconomic position interacted with multimorbidity to determine COVID-19 severity with a mitigated risk among the socioeconomically advantaged. Plausible explanations include the underlying socioeconomic inequalities in chronic disease management and the equity impact of the public-private dual-track healthcare system.</description><identifier>ISSN: 1660-4601</identifier><identifier>ISSN: 1661-7827</identifier><identifier>EISSN: 1660-4601</identifier><identifier>DOI: 10.3390/ijerph18158168</identifier><identifier>PMID: 34360461</identifier><language>eng</language><publisher>Switzerland: MDPI AG</publisher><subject>Chronic illnesses ; Comorbidity ; COVID-19 ; Epidemics ; Hong Kong - epidemiology ; Households ; Humans ; Multimorbidity ; Poverty ; SARS-CoV-2 ; Socioeconomic Factors ; Socioeconomics ; Syndemic</subject><ispartof>International journal of environmental research and public health, 2021-08, Vol.18 (15), p.8168</ispartof><rights>2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2021 by the authors. 2021</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c418t-77d0aae53bbdc6a64aac3f1847f2debd4cf98a9d330adb3a037896f9f2c755ce3</citedby><cites>FETCH-LOGICAL-c418t-77d0aae53bbdc6a64aac3f1847f2debd4cf98a9d330adb3a037896f9f2c755ce3</cites><orcidid>0000-0001-7593-3081 ; 0000-0003-4407-8208 ; 0000-0003-0580-289X ; 0000-0001-8326-9766 ; 0000-0003-0934-6385 ; 0000-0002-8652-212X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8346110/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8346110/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34360461$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chung, Gary Ka-Ki</creatorcontrib><creatorcontrib>Chan, Siu-Ming</creatorcontrib><creatorcontrib>Chan, Yat-Hang</creatorcontrib><creatorcontrib>Yip, Terry Cheuk-Fung</creatorcontrib><creatorcontrib>Ma, Hon-Ming</creatorcontrib><creatorcontrib>Wong, Grace Lai-Hung</creatorcontrib><creatorcontrib>Chung, Roger Yat-Nork</creatorcontrib><creatorcontrib>Wong, Hung</creatorcontrib><creatorcontrib>Wong, Samuel Yeung-Shan</creatorcontrib><creatorcontrib>Yeoh, Eng Kiong</creatorcontrib><creatorcontrib>Marmot, Michael</creatorcontrib><creatorcontrib>Woo, Jean</creatorcontrib><title>Differential Impacts of Multimorbidity on COVID-19 Severity across the Socioeconomic Ladder in Hong Kong: A Syndemic Perspective</title><title>International journal of environmental research and public health</title><addtitle>Int J Environ Res Public Health</addtitle><description>The severity of COVID-19 infections could be exacerbated by the epidemic of chronic diseases and underlying inequalities in social determinants of health. 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| subjects | Chronic illnesses Comorbidity COVID-19 Epidemics Hong Kong - epidemiology Households Humans Multimorbidity Poverty SARS-CoV-2 Socioeconomic Factors Socioeconomics Syndemic |
| title | Differential Impacts of Multimorbidity on COVID-19 Severity across the Socioeconomic Ladder in Hong Kong: A Syndemic Perspective |
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