Social determinants of COVID-19 incidence and outcomes: A rapid review

PLoS One. 2021 Mar 31;16(3):e0248336. doi: 10.1371/journal.pone.0248336. eCollection 2021.

Abstract

Early reports indicate that the social determinants of health are implicated in COVID-19 incidence and outcomes. To inform the ongoing response to the pandemic, we conducted a rapid review of peer-reviewed studies to examine the social determinants of COVID-19. We searched Ovid MEDLINE, Embase, PsycINFO, CINAHL and Cochrane Central Register of Controlled Trials from December 1, 2019 to April 27, 2020. We also searched the bibliographies of included studies, COVID-19 evidence repositories and living evidence maps, and consulted with expert colleagues internationally. We included studies identified through these supplementary sources up to June 25, 2020. We included English-language peer-reviewed quantitative studies that used primary data to describe the social determinants of COVID-19 incidence, clinical presentation, health service use and outcomes in adults with a confirmed or presumptive diagnosis of COVID-19. Two reviewers extracted data and conducted quality assessment, confirmed by a third reviewer. Forty-two studies met inclusion criteria. The strongest evidence was from three large observational studies that found associations between race or ethnicity and socioeconomic deprivation and increased likelihood of COVID-19 incidence and subsequent hospitalization. Limited evidence was available on other key determinants, including occupation, educational attainment, housing status and food security. Assessing associations between sociodemographic factors and COVID-19 was limited by small samples, descriptive study designs, and the timeframe of our search. Systematic reviews of literature published subsequently are required to fully understand the magnitude of any effects and predictive utility of sociodemographic factors related to COVID-19 incidence and outcomes. PROSPERO: CRD4202017813.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • COVID-19 / diagnosis
  • COVID-19 / epidemiology*
  • COVID-19 / ethnology
  • Humans
  • Incidence
  • Prognosis
  • Racial Groups / statistics & numerical data
  • Social Determinants of Health / statistics & numerical data*

Grants and funding

This project was supported in part by an Early Researcher Award from the Government of Ontario, held by Andrew Pinto, and a University of Toronto COVID-19 Student Engagement Award, which supported Tara Upshaw and Chloe Brown. Tara Upshaw is supported by a Canada Graduate Scholarship from the Canadian Institutes for Health Research. Andrew Pinto is supported as a Clinician-Scientist by the Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, the Department of Family and Community Medicine, St. Michael’s Hospital, and the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, by a fellowship from the Physicians’ Services Incorporated Foundation and as the Associate Director for Clinical Research at the University of Toronto Practice-Based Research Network (UTOPIAN). The opinions, results and conclusions reported in this article are those of the authors and are independent from any funding sources.