Purpose
This note provides a summary of preliminary evidence showing that structural inequities and the social
determinants of health (SDOH) – such as race/ethnicity, indigeneity, sex/gender, socioeconomic position, occupation (i.e., precarious employment), incarceration, and homelessness – may contribute to increased risk of COVID-19 infection, hospitalization, and mortality.
*The full Briefing Note including the Summary of Evidence and Appendix can be accessed in the PDF File located at the top of the page*
Key Findings
- There is little identified research or jurisdictional information on the specific barriers to adherence to COVID-19 public health measures.
- Preliminary research demonstrates an unequal social and economic burden of COVID-19 internationally, with emerging evidence of this relationship from Ontario and Quebec.
- SDOH play an important role in risk of COVID-19 infection, particularly when they limit ability to maintain physical distancing.
- Existing social inequities in health increase risk of severe COVID-19 outcomes through increased prevalence of underlying medical conditions and/or decreased access to health care.
Analysis for Ontario:
- Ontario demonstrates the impact of four SDOH on the risk of COVID-19 exposure or outcomes.
- Race/Ethnicity: Ontario announced plans to begin collecting individual-level race/ethnicity and income data as part of COVID-19 surveillance.
- Homelessness: COVID-19 outbreaks have been reported in shelters by public health officials in Toronto.
- Precarious Employment: Low-income workers (e.g., essential worker cashiers) in Toronto reported a high exposure risk (e.g., physical proximity to others) to COVID-19 at work.
- Neighbourhood Deprivation: Results from the Ontario Laboratories Information System (OLIS) database suggest that, as of April 30, 2020, a higher percentage of confirmed positive COVID-19 tests was observed in neighbourhood quintiles with the highest ethnic concentration, greatest material deprivation, and the lowest income compared to the least marginalized quintiles.
Supporting Evidence
*The entirety of the Supporting Evidence section can be accessed in the PDF file located at the top of the page*
While the search for scientific evidence linking SDOH directly to rates of COVID-19 infection was extremely limited, preliminary evidence from international surveillance and media reports on links between SDOH and increased prevalence of underlying medical conditions and/or decreased access to health care suggest a likely relationship between SDOH and COVID-19 rates. Racialized (such as Black, Latino and other ethnic minorities) and low-income populations have disproportionately high rates of COVID-19 infection, hospitalization, and mortality in the United States and the United Kingdom. There is also emerging evidence that provides support for these relationships existing in Ontario and Quebec.
Methods
The COVID-19 Evidence Synthesis Network is comprised of groups specializing in evidence synthesis and knowledge translation. The group has committed to provide their expertise to provide high-quality, relevant, and timely synthesized research evidence about COVID-19 to inform decision makers as the pandemic continues. The following members of the Network provided evidence synthesis products that were used to develop this Evidence Synthesis Briefing Note:
- Public Health Ontario. May 24, 2020. COVID-19 – What We Know So Far About… Social Determinants of Health: A Synopsis.
- Research, Analysis and Evaluation Branch – Ontario Ministry of Health. 812. Infection Prevention and Control Strategies for People Experiencing Homelessness 21-MAY-2020 (MooreJ – RAE)