Abstract
Objectives
We measured disparities in COVID-19 mortality associated with increasing vulnerability to severe outcomes of infectious disease at the neighbourhood level to identify domains for prioritization of public interventions.
Methods
In this retrospective ecological study, we calculated COVID-19 mortality rate ratios (RR) comparing neighbourhoods with the greatest vulnerability relative to lowest vulnerability using the five domains from the COVID-19 vulnerability index for Quebec using hospital data from the first year of the pandemic and vulnerability levels from 13,182 neighbourhoods. We estimated the attributable fraction to assess disparities in COVID-19 mortality associated with vulnerability. Domains covered biological susceptibility, sociocultural characteristics, socioeconomic characteristics, and indoor and outdoor risk factors for exposure to SARS-CoV-2.
Results
Vulnerable neighbourhoods accounted for 60.7% of COVID-19 deaths between March 2020 and February 2021. Neighbourhoods with biological susceptibility accounted for 46.1% and indoor exposure for 44.6% of deaths. Neighbourhoods with socioeconomic vulnerability experienced 23.5%, outdoor exposure 14.6%, and sociocultural vulnerability 9.0% of deaths. Neighbourhoods with high relative vulnerability had 4.66 times greater risk of COVID-19 mortality compared with those with low vulnerability (95%CI 3.82-5.67). High vulnerability in the biological (RR 3.33; 95%CI 2.71-4.09), sociocultural (RR 1.50; 95%CI 1.27-1.77), socioeconomic (RR 2.08; 95%CI 1.75-2.48), and indoor (RR 3.21; 95%CI 2.74-3.76) exposure domains were associated with elevated risks of mortality compared with the least vulnerable neighbourhoods. Outdoor exposure was unassociated with mortality (RR 1.17; 95%CI 0.96-2.43).
Conclusion
Public intervention to protect vulnerable populations should be adapted to focus on domains most associated with COVID-19 mortality to ensure addressing local needs.
Résumé
Objectifs
Nous avons mesuré les inégalités de mortalité de COVID-19 associées à la vulnérabilité croissante des conséquences sévères de maladies infectieuses au Québec. L’échelle de quartier permet d’identifier des domaines à prioriser lors d’interventions publiques.
Méthodes
Dans cette étude écologique rétrospective, nous avons calculé des ratios des taux (RT) en comparant les territoires de plus grande vulnérabilité avec ceux de plus faible vulnérabilité à l’aide de données d’hospitalisation de la première année de la pandémie et de mesures de vulnérabilité de 13 182 aires de diffusion (AD). Nous avons estimé la fraction attribuable pour évaluer les disparités de mortalité par la COVID-19. Les domaines examinés concernaient la susceptibilité biologique, les caractéristiques socioculturelles et socioéconomiques ainsi que des facteurs de risque d’exposition au SRAS-CoV-2 à l’intérieur et à l’extérieur.
Résultats
Dans l’ensemble, les territoires vulnérables couvraient 60,7 % des cas de mortalité de COVID-19 pendant la première année de la pandémie. Les AD avec une vulnérabilité élevée avaient un risque de mortalité par la COVID-19 4,66 fois plus élevé comparé aux territoires de faible vulnérabilité (IC de 95% 3,82-5,67). Les aires de diffusion avec une susceptibilité biologique comptaient pour 46,1 % des décès et celles avec une exposition au SRAS-CoV-2 à l’intérieur pour 44,6 %. La vulnérabilité socioéconomique comptait pour 23,5 %, l’exposition à l’extérieur pour 14,6 %, et la vulnérabilité socioculturelle pour 9,0 % des décès. Les domaines biologique (RT 3,33; IC de 95% 2,71-4,09), socioculturel (RT 1,50; IC de 95% 1,27-1,77), socioéconomique (RT 2,08; IC de 95% 1,75-2,48), et d’exposition intérieure (RT 3,21; IC de 95% 2,74-3,76) étaient associés à un risque élevé de mortalité par la COVID-19 comparé aux territoires les moins vulnérables. L’exposition extérieure n’était pas associée avec un risque de mortalité par la COVID-19 (RT 1,17; IC de 95% 0,96-2,43).
Conclusion
Les interventions publiques visant à protéger les populations vulnérables devraient être adaptées aux domaines les plus associés avec la mortalité par la COVID-19 au Québec et ce, à l’échelle de quartier pour s’assurer que les besoins locaux soient couverts.
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CB conceived and developed the IVS and the study. CB and NA collected the data. CB analyzed the data. KF and LG provided input on the development of the IVS. CB and NA drafted the paper. EB reviewed the manuscript. All authors edited the manuscript and approved the final version.
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Data from Social Vulnerability Index for Quebec (SVIQ) downloadable from: vulnerabilitecovid.cbcr.me
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Blaser, C., Gautier, L., Brousseau, É. et al. Inequality in COVID-19 mortality in Quebec associated with neighbourhood-level vulnerability domains. Can J Public Health 115, 53–66 (2024). https://doi.org/10.17269/s41997-023-00829-7
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DOI: https://doi.org/10.17269/s41997-023-00829-7