tetano
Editor, Senior Moderator
BMC Public Health
. 2022 Dec 3;22(1):2256.
doi: 10.1186/s12889-022-14532-8.
Social determinants of health associated with COVID-19 severity during pregnancy: a multinational cohort study (in the International Registry of Coronavirus Exposure in Pregnancy)
Jasmine A Mack[SUP] 1 [/SUP], Erica A Voss[SUP] 1 [/SUP], Rada Rusu[SUP] 2 [/SUP], Meg Celine Hernandez[SUP] 1 [/SUP], Sonia Hernandez-Diaz[SUP] 3 [/SUP], Diego F Wyszynski[SUP] 4 [/SUP], Shirley Sylvester[SUP] 2 [/SUP], Rachael L DiSantostefano[SUP] 5 [/SUP]
Affiliations
Abstract
Background: The COVID-19 pandemic has caused morbidity and mortality, particularly among vulnerable populations. We aimed to assess social and demographic characteristics associated with COVID-19 severity among symptomatic participants during pregnancy.
Methods: The International Registry of Coronavirus Exposure in Pregnancy is a multinational, longitudinal observational cohort study of adult participants tested for SARS-CoV-2 or who received clinical diagnosis of COVID-19 during pregnancy (NCT04366986). Disease severity status of mild, moderate, or severe was determined based on symptoms and healthcare utilization. Stratified by current versus recent pregnancy at enrollment, univariate mixed-effects logistic regression modeling was used to characterize association between social and demographic characteristics with COVID-19 severity, using a cumulative mixed effect model with country as a random effect.
Results: The odds of developing more severe COVID-19 (odds ratio [95% confidence interval]) were higher among participants with lower socioeconomic status (poor: 2.72 [2.01,3.69]; lower-middle class: 2.07 [1.62,2.65] vs wealthy), among participants with lower educational attainment (high school: 1.68 [1.39,2.03]; < high school (1.77 [1.25,2.51] vs graduate education). Participants over 25 years of age had lower odds of severe COVID-19 versus participants < 25 years (25-34: 0.69 [0.56,0.85]; 35-50: 0.62 [0.48,0.80]). Employment in food services was also associated with increased odds of more severe COVID-19, whereas employment in healthcare and within home, and primiparity were associated with lower severity.
Conclusions: Findings suggest that employment setting and economic status have strong associations with COVID-19 severity, which warrants considering social determinants of health in the context of assessing risk factors of more severe COVID-19 during pregnancy.
Trial registration: IRCEP was registered with the European Network of Centres for Pharmacoepidemiology and Pharmacovigilance (ENCePP) [EUPAS37360] and clinicaltrials.gov [NCT04366986].
Keywords: Behaviors; COVID-19; Pregnancy; Social determinants of health.
. 2022 Dec 3;22(1):2256.
doi: 10.1186/s12889-022-14532-8.
Social determinants of health associated with COVID-19 severity during pregnancy: a multinational cohort study (in the International Registry of Coronavirus Exposure in Pregnancy)
Jasmine A Mack[SUP] 1 [/SUP], Erica A Voss[SUP] 1 [/SUP], Rada Rusu[SUP] 2 [/SUP], Meg Celine Hernandez[SUP] 1 [/SUP], Sonia Hernandez-Diaz[SUP] 3 [/SUP], Diego F Wyszynski[SUP] 4 [/SUP], Shirley Sylvester[SUP] 2 [/SUP], Rachael L DiSantostefano[SUP] 5 [/SUP]
Affiliations
- PMID: 36463160
- DOI: 10.1186/s12889-022-14532-8
Abstract
Background: The COVID-19 pandemic has caused morbidity and mortality, particularly among vulnerable populations. We aimed to assess social and demographic characteristics associated with COVID-19 severity among symptomatic participants during pregnancy.
Methods: The International Registry of Coronavirus Exposure in Pregnancy is a multinational, longitudinal observational cohort study of adult participants tested for SARS-CoV-2 or who received clinical diagnosis of COVID-19 during pregnancy (NCT04366986). Disease severity status of mild, moderate, or severe was determined based on symptoms and healthcare utilization. Stratified by current versus recent pregnancy at enrollment, univariate mixed-effects logistic regression modeling was used to characterize association between social and demographic characteristics with COVID-19 severity, using a cumulative mixed effect model with country as a random effect.
Results: The odds of developing more severe COVID-19 (odds ratio [95% confidence interval]) were higher among participants with lower socioeconomic status (poor: 2.72 [2.01,3.69]; lower-middle class: 2.07 [1.62,2.65] vs wealthy), among participants with lower educational attainment (high school: 1.68 [1.39,2.03]; < high school (1.77 [1.25,2.51] vs graduate education). Participants over 25 years of age had lower odds of severe COVID-19 versus participants < 25 years (25-34: 0.69 [0.56,0.85]; 35-50: 0.62 [0.48,0.80]). Employment in food services was also associated with increased odds of more severe COVID-19, whereas employment in healthcare and within home, and primiparity were associated with lower severity.
Conclusions: Findings suggest that employment setting and economic status have strong associations with COVID-19 severity, which warrants considering social determinants of health in the context of assessing risk factors of more severe COVID-19 during pregnancy.
Trial registration: IRCEP was registered with the European Network of Centres for Pharmacoepidemiology and Pharmacovigilance (ENCePP) [EUPAS37360] and clinicaltrials.gov [NCT04366986].
Keywords: Behaviors; COVID-19; Pregnancy; Social determinants of health.