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Graduate Student (MPH Epi Track)
Name of Faculty Advisor
The impact of social determinants of health have been amplified during the pandemic and associated with COVID-19 incidence and mortality rates.
The literature review will identify the recent evidence of specific social determinants of health within the context of the pandemic that are important to consider for prevention of the spread of infectious diseases, specifically COVID-19.
A search was conducted using PubMED for empirical research evaluating the relationship of social determinants of health and COVID-19 published since 2019. Key terms were “COVID-19” or “CORONAVIRUS” or “2019-nCoV” or “SARS” or ‘MERS” and “social determinants of health”. Inclusion criteria were articles in English and peer reviewed. Exclusion criteria were non-data based articles (e.g., editorials, opinion or commentary). The search yielded 427 citations and 25 articles met inclusion and exclusion criteria.
Results of literature search
The review identified a scarcity of descriptive research that explicitly explored the impact of social determinants of health. Studies were conducted across the globe. Sample characteristics included communities of diverse racial and ethnic backgrounds, essential workers, and college students. Three social determinants of health were associated with COVID-19: employment, income, and level of education.
Synthesis of evidence
Characteristics of employment such as being an essential worker, travel time to work, and unsafe working conditions were associated with higher risk for exposure and incidence. Changes in employment status led to reduced income, loss of health insurance coverage, and loss of eligibility for benefits or government aid. Reduced income was associated with increased incidence rates, more hospitalizations, and higher mortality rates. Similarly, lower level of education (less than high school diploma) was also associated with higher incidence and mortality rates. Communities with a higher proportion of Blacks and Hispanics experience a greater burden of the disease. In addition, six studies found a rise in depression and anxiety.
Implications for practice
This review identifies specific determinants associated with COVID-19 for public health action despite little research conducted. Policy must address social determinants of health explicitly to reach target populations. Strategies to protect or prevent vulnerable populations from continuing to be affected at higher rates must be considered in future research.
Social Determinants of Health and COVID-19: A Literature Review