From test to rest: evaluating socioeconomic differences along the COVID-19 care pathway in the Netherlands

Iris Meulman (), Ellen Uiters, Mariëlle Cloin, Jeroen Struijs, Johan Polder and Niek Stadhouders
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Iris Meulman: Tilburg University
Ellen Uiters: National Institute for Public Health and the Environment
Mariëlle Cloin: Tilburg University
Jeroen Struijs: National Institute for Public Health and the Environment
Johan Polder: Tilburg University
Niek Stadhouders: Radboud University Medical Center

The European Journal of Health Economics, 2024, vol. 25, issue 9, No 9, 1594 pages

Abstract: Abstract Introduction The COVID-19 pandemic exacerbated healthcare needs and caused excess mortality, especially among lower socioeconomic groups. This study describes the emergence of socioeconomic differences along the COVID-19 pathway of testing, healthcare use and mortality in the Netherlands. Methodology This retrospective observational Dutch population-based study combined individual-level registry data from June 2020 to December 2020 on personal socioeconomic characteristics, COVID-19 administered tests, test results, general practitioner (GP) consultations, hospital admissions, Intensive Care Unit (ICU) admissions and mortality. For each outcome measure, relative differences between income groups were estimated using log-link binomial regression models. Furthermore, regression models explained socioeconomic differences in COVID-19 mortality by differences in ICU/hospital admissions, test administration and test results. Results Among the Dutch population, the lowest income group had a lower test probability (RR = 0.61) and lower risk of testing positive (RR = 0.77) compared to the highest income group. However, among individuals with at least one administered COVID-19 test, the lowest income group had a higher risk of testing positive (RR = 1.40). The likelihood of hospital admissions and ICU admissions were higher for low income groups (RR = 2.11 and RR = 2.46, respectively). The lowest income group had an almost four times higher risk of dying from COVID-19 (RR = 3.85), which could partly be explained by a higher risk of hospitalization and ICU admission, rather than differences in test administration or result. Discussion Our findings indicated that socioeconomic differences became more pronounced at each step of the care pathway, culminating to a large gap in mortality. This underlines the need for enhancing social security and well-being policies and incorporation of health equity in pandemic preparedness plans.

Keywords: Socioeconomic inequality; COVID-19 testing; COVID-19 healthcare utilization; COVID-19 mortality (search for similar items in EconPapers)
JEL-codes: I14 I18 (search for similar items in EconPapers)
Date: 2024
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DOI: 10.1007/s10198-024-01680-4

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