COVID-19: bucking the socioeconomic trend?
The growing COVID-19 disaster is an increasing threat to all facets of our lives, in particular it is the economic, health and education systems which are those most threatened.
The 24 hr news deluge is making is difficult to escape the tragedy that is unfolding across the planet, and has led me to think about the population groups that are going to be most impacted.
The linkage between socioeconomic status and health outcomes is well documented across a range of conditions, whether it be previous viral pandemics[1], non-communicable diseases[2] or deaths on the Titanic[3].
So it was of interest to see where the first cases in Australia were located: were they evenly spread across society or concentrated in some areas?
As the first reports of local cases and people in quarantine came to light, an interesting pattern emerged of the locations and backgrounds of the those effected: a Hollywood actor; TV entertainment journalist; a Toorak general practitioner; Bondi dance party; Aspen ski group; a teacher, student and parents from elite private schools.
Is this going to be a disease of the affluent? Those (un)fortunate enough to travel overseas seem to be the first infected in Australia, and this social gradient was confirmed when NSW and Victoria commenced publishing the place of residence of these cases.
Figure 1 and 2 below illustrate the spread of cases across a socioeconomic index. The Australian Bureau of Statistics publishes the Index of Relative Socioeconomic Disadvantage (IRSD) for geographic areas. On a national basis, local government areas can be compared, with the most disadvantaged 20 per cent in quartile 1 and the least disadvantaged 20 per cent in quartile 5.
These Figures illustrate that more than half of the cases (51.2 per cent in Victoria and 56.5 per cent in NSW) were in residents of areas that are among the least disadvantaged 20 per cent of the Australian population. Cases are concentrated in the affluent inner south east suburbs of Melbourne and the Mornington Peninsula in Victoria and the North Shore and eastern suburbs in Sydney (Figure 3).
As this tragedy further unfolds, it will be interesting to see if the prevalence trends continue and if hospitalisation and mortality data follow the same trends or if they revert to the historical patterns of greater impact among the most disadvantaged.
It is probably without doubt that the economic and employment impacts will be greatest among the most disadvantaged.
Figure 1: Proportion of COVID-19 cases in Victoria and population by SEIFA IRSD quartile (28 March 2020)
Source: Analysis of DHHS dhhs.vic.gov.au/coronavirus; ABS 3218.0 Regional Population Growth, Australia; ABS SEIFA indices 2016
Figure 2: Proportion of COVID-19 cases in NSW and population by SEIFA IRSD quartile (28 March 2020)
Source: Analysis of NSW Health https://www.health.nsw.gov.au/Infectious/diseases/Pages/covid-19-lga.aspx; ABS 3218.0 Regional Population Growth, Australia; ABS SEIFA indices 2016
Figure 3: Confirmed cases of COVID 19 in Sydney Metropolitan region as of 8pm 28 March 2020 by Local Government Area
Source: NSW Health https://www.health.nsw.gov.au/Infectious/diseases/Pages/covid-19-lga.aspx
[1] (Mamelund, et al., 2019)
[2] (Australian Institute of Health and Welfare, 2019)
[3] (Bier, 2018)
References:
Australian Institute of Health and Welfare, 2019. Indicators of socioeconomic inequalities in cardiovascular disease, diabetes and chronic kidney disease, Canberra: AIHW.
Bier, J., 2018. Bodily circulation and the measure of a life: Forensic identification and valuation after the Titanic disaster. Bodily circulation and the measure of a life: Forensic identification and valuation after the Titanic disaster, 28 September, 48(5), pp. 635-662.
Mamelund, S., Shelley-Egan, C. & Rogeberg, O., 2019. The association between socioeconomic status and pandemic influenza: protocol for a systematic review and meta-analysis. Systematic Reviews volume, 8(5).