Socioeconomic Status and Adherence to Preventive Measures During the COVID-19 Pandemic in Switzerland: A Population Based Digital Cohort Analysis

Stefano Tancredi; Bernadette W A van der Linden; Arnaud Chiolero; Stéphane Cullati; Medea Imboden; Nicole Probst-Hensch; Dirk Keidel; Melissa Witzig; Julia Dratva; Gisela Michel; Erika Harju; Irene Frank; Elsa Lorthe; Hélène Baysson; Silvia Stringhini; Christian R Kahlert; Julia B Bardoczi; Moa Lina Haller; Patricia O Chocano-Bedoya; Nicolas Rodondi; Rebecca Amati; Emiliano Albanese; Laurie Corna; Luca Crivelli; Marco Kaufmann; Anja Frei; Viktor von Wyl

doi:10.3389/ijph.2024.1606861

Socioeconomic Status and Adherence to Preventive Measures During the COVID-19 Pandemic in Switzerland: A Population Based Digital Cohort Analysis

Int J Public Health. 2024 Jul 3:69:1606861. doi: 10.3389/ijph.2024.1606861. eCollection 2024.

Authors

Stefano Tancredi¹, Bernadette W A van der Linden¹, Arnaud Chiolero^{1

2

3}, Stéphane Cullati^{1

4}, Medea Imboden^{5

6}, Nicole Probst-Hensch^{5

6}, Dirk Keidel^{5

6}, Melissa Witzig^{5

6}, Julia Dratva^{6

7}, Gisela Michel⁸, Erika Harju^{8

9}, Irene Frank¹⁰, Elsa Lorthe^{11

12}, Hélène Baysson¹¹, Silvia Stringhini^{11

13

14

15}, Christian R Kahlert^{16

17}, Julia B Bardoczi^{3

18}, Moa Lina Haller³, Patricia O Chocano-Bedoya³, Nicolas Rodondi^{3

18}, Rebecca Amati¹⁹, Emiliano Albanese¹⁹, Laurie Corna²⁰, Luca Crivelli^{19

20}, Marco Kaufmann²¹, Anja Frei²¹, Viktor von Wyl^{21

22}

Affiliations

¹ Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland.
² School of Population and Global Health, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada.
³ Institute of Primary Healthcare (BIHAM), University of Bern, Bern, Switzerland.
⁴ Quality of Care Service, Geneva University Hospitals, Geneva, Switzerland.
⁵ Swiss Tropical and Public Health Institute, Allschwil, Switzerland.
⁶ University of Basel, Basel, Switzerland.
⁷ Zurich University of Applied Sciences, Winterthur, Switzerland.
⁸ Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
⁹ School of Health Sciences, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland.
¹⁰ Clinical Trial Unit, Cantonal Hospital Lucerne, Lucerne, Switzerland.
¹¹ Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland.
¹² Université Paris Cité, INSERM, INRAE, Centre for Research in Epidemiology and Statistics Paris (CRESS), Paris, France.
¹³ Department of Health and Community Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
¹⁴ University Center of General Medicine and Public Health, Lausanne, Switzerland.
¹⁵ School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
¹⁶ Cantonal Hospital St Gallen, Division of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland.
¹⁷ Children's Hospital of Eastern Switzerland, Department of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland.
¹⁸ Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
¹⁹ Institute of Public Health, Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland.
²⁰ Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland.
²¹ Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
²² Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland.

Abstract

Objectives: To assess the association between socioeconomic status (SES) and self-reported adherence to preventive measures in Switzerland during the COVID-19 pandemic.

Methods: 4,299 participants from a digital cohort were followed between September 2020 and November 2021. Baseline equivalised disposable income and education were used as SES proxies. Adherence was assessed over time. We investigated the association between SES and adherence using multivariable mixed logistic regression, stratifying by age (below/above 65 years) and two periods (before/after June 2021, to account for changes in vaccine coverage and epidemiological situation).

Results: Adherence was high across all SES strata before June 2021. After, participants with higher equivalised disposable income were less likely to adhere to preventive measures compared to participants in the first (low) quartile [second (Adj.OR, 95% CI) (0.56, 0.37-0.85), third (0.38, 0.23-0.64), fourth (0.60, 0.36-0.98)]. We observed similar results for education.

Conclusion: No differences by SES were found during the period with high SARS-CoV-2 incidence rates and stringent measures. Following the broad availability of vaccines, lower incidence, and eased measures, differences by SES started to emerge. Our study highlights the need for contextual interpretation when assessing SES impact on adherence to preventive measures.

Keywords: COVID-19 pandemic; SARS-CoV-2; income; preventive measures; socioeconomic status.

Copyright © 2024 Tancredi, van der Linden, Chiolero, Cullati, Imboden, Probst-Hensch, Keidel, Witzig, Dratva, Michel, Harju, Frank, Lorthe, Baysson, Stringhini, Kahlert, Bardoczi, Haller, Chocano-Bedoya, Rodondi, Amati, Albanese, Corna, Crivelli, Kaufmann, Frei and von Wyl.

MeSH terms

Adult
Aged
COVID-19* / epidemiology
COVID-19* / prevention & control
Cohort Studies
Female
Humans
Male
Middle Aged
Pandemics
Patient Compliance / statistics & numerical data
SARS-CoV-2*
Social Class*
Switzerland / epidemiology

Grants and funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This study was funded by several sources that includes, but is not limited to, SSPH+ and the Swiss Federal Office of Public Health. COVCO-Basel was additionally funded by the health directorates of the cantons of Basel-Stadt and Basel-Landschaft. Funders had no influence on the design, conduct, analyses and publications.