The association of combinations of social factors and SARs-CoV-2 infection: A retrospective population-based cohort study in Ontario, 2020-2021

Sydney Persaud; Michael Fitzgerald; Steven Hawken; Peter Tanuseputro; Lisa Boucher; William Petrcich; Martin Wellman; Colleen Webber; Esther Shoemaker; Robin Ducharme; Simone Dahrouge; Daniel Myran; Ahmed M Bayoumi; Susitha Wanigaratne; Gary Bloch; David Ponka; Brendan T Smith; Aisha Lofters; Austin Zygmunt; Krystal Kehoe MacLeod; Luke A Turcotte; Beate Sander; Michelle Howard; Sarah Funnell; Jennifer Rayner; Kurtis Kitagawa; Sureya Ibrahim; Claire E Kendall

doi:10.1016/j.dialog.2024.100197

The association of combinations of social factors and SARs-CoV-2 infection: A retrospective population-based cohort study in Ontario, 2020-2021

Dialogues Health. 2024 Oct 29:5:100197. doi: 10.1016/j.dialog.2024.100197. eCollection 2024 Dec.

Authors

Sydney Persaud¹, Michael Fitzgerald¹, Steven Hawken^{2

3

4}, Peter Tanuseputro^{1

2

5}, Lisa Boucher¹, William Petrcich², Martin Wellman^{2

3}, Colleen Webber^{1

2

3}, Esther Shoemaker¹, Robin Ducharme³, Simone Dahrouge^{1

2

5}, Daniel Myran^{1

2

3

5}, Ahmed M Bayoumi^{6

7

8

9

10}, Susitha Wanigaratne^{2

11}, Gary Bloch^{12

13}, David Ponka^{1

5}, Brendan T Smith^{12

14}, Aisha Lofters^{2

7

12

15}, Austin Zygmunt^{5

14}, Krystal Kehoe MacLeod^{1

3

5}, Luke A Turcotte¹⁶, Beate Sander^{2

6

14

17}, Michelle Howard¹⁸, Sarah Funnell^{19

20}, Jennifer Rayner^{6

15

21}, Kurtis Kitagawa¹, Sureya Ibrahim²², Claire E Kendall^{1

2

4

5

7}

Affiliations

¹ Bruyère Health Research Institute, Ottawa, Ontario, Canada.
² ICES, Ottawa, Ontario, Canada.
³ Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
⁴ School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
⁵ Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada.
⁶ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
⁷ Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
⁸ Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada.
⁹ Department of Medicine, University of Toronto, Toronto, ON, Canada.
¹⁰ Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada.
¹¹ Edwin S.H. Leong Center for Healthy Children, University of Toronto, Toronto, Ontario, Canada.
¹² Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
¹³ Unity Health, Toronto, Ontario, Canada.
¹⁴ Public Health Ontario, Toronto, Ontario, Canada.
¹⁵ Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
¹⁶ Department of Health Sciences, Brock University, St. Catharines, Ontario, Canada.
¹⁷ Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada.
¹⁸ Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada.
¹⁹ Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada.
²⁰ Department of Family Medicine, Queen's University, Kingston, Ontario, Canada.
²¹ Alliance for Healthier Communities, Toronto, Ontario, Canada.
²² Centre for Community Learning & Development, Toronto, Ontario M5A 2B3, Canada.

Abstract

Objective: The COVID-19 pandemic highlighted and exacerbated health inequities worldwide. While several studies have examined the impact of individual social factors on COVID infection, our objective was to examine how interactions of social factors were associated with the risk of testing positive for SARS-CoV-2 during the first two years of the pandemic.

Study design and setting: We conducted an observational cohort study using linked health administrative data for Ontarians tested for SARS-CoV-2 between January 1st, 2020, and December 31st, 2021. We constructed multivariable models to examine the association between SARS-CoV-2 positivity and key variables including immigration status (immigrants vs. other Ontarians), and neighbourhood variables for household size, income, essential worker status, and visible minority status. We report main and interaction effects using odds ratios and predicted probabilities, with age and sex controlled in all models.

Results: Of 6,575,523 Ontarians in the cohort, 88.5 % tested negative, and 11.5 % tested positive for SARS-CoV-2. In all models, immigrants and those living in neighbourhoods with large average household sizes had greater odds of testing positive for SARS-CoV-2. The strength of these associations increased with increasing levels of neighbourhood marginalization for income, essential worker proportion and visible minority proportion. We observed little change in the probability of testing positive across neighbourhood income quintiles among other Ontarians who live in neighbourhoods with smaller households, but a large change in probability among other Ontarians who live in neighbourhoods with larger households.

Conclusion: Our study found that SARS-CoV-2 positivity was greater among people with certain combinations of social factors, but in all cases the probability of testing positive was consistently greater for immigrants than for other Ontarians. Examining interactions of social factors can provide a more nuanced and more comprehensive understanding of health inequity than examining factors separately.

Keywords: COVID-19 positivity; Health equity; SARS-CoV-2; Social determinants of health.