Scottish Index of Multiple Deprivation (SIMD) indicators as predictors of mortality among patients hospitalised with COVID-19 disease in the Lothian Region, Scotland during the first wave: a cohort study.
Covid-19
Deprivation
Mortality
SIMD indicators
Journal
International journal for equity in health
ISSN: 1475-9276
Titre abrégé: Int J Equity Health
Pays: England
ID NLM: 101147692
Informations de publication
Date de publication:
05 10 2023
05 10 2023
Historique:
received:
22
11
2021
accepted:
18
09
2023
medline:
1
11
2023
pubmed:
5
10
2023
entrez:
4
10
2023
Statut:
epublish
Résumé
Sars-CoV-2, the causative agent of COVID-19, has led to more than 226,000 deaths in the UK and multiple risk factors for mortality including age, sex and deprivation have been identified. This study aimed to identify which individual indicators of the Scottish Index of Multiple Deprivation (SIMD), an area-based deprivation index, were predictive of mortality. This was a prospective cohort study of anonymised electronic health records of 710 consecutive patients hospitalised with Covid-19 disease between March and June 2020 in the Lothian Region of Southeast Scotland. Data sources included automatically extracted data from national electronic platforms and manually extracted data from individual admission records. Exposure variables of interest were SIMD quintiles and 12 indicators of deprivation deemed clinically relevant selected from the SIMD. Our primary outcome was mortality. Age and sex adjusted univariable and multivariable analyses were used to determine measures of association between exposures of interest and the primary outcome. After adjusting for age and sex, we found an increased risk of mortality in the more deprived SIMD quintiles 1 and 3 (OR 1.75, CI 0.99-3.08, p = 0.053 and OR 2.17, CI 1.22-3.86, p = 0.009, respectively), but this association was not upheld in our multivariable model containing age, sex, Performance Status and clinical parameters of severity at admission. Of the 12 pre-selected indicators of deprivation, two were associated with greater mortality in our multivariable analysis: income deprivation rate categorised by quartile (Q4 (most deprived): 2.11 (1.20-3.77) p = 0.011)) and greater than expected hospitalisations due to alcohol per SIMD data zone (1.96 (1.28-3.00) p = 0.002)). SIMD as an aggregate measure of deprivation was not predictive of mortality in our cohort when other exposure measures were accounted for. However, we identified a two-fold increased risk of mortality in patients residing in areas with greater income-deprivation and/or number of hospitalisations due to alcohol. In areas where aggregate measures fail to capture pockets of deprivation, exploring the impact of specific SIMD indicators may be helpful in targeting resources to residents at risk of poorer outcomes from Covid-19.
Sections du résumé
BACKGROUND
Sars-CoV-2, the causative agent of COVID-19, has led to more than 226,000 deaths in the UK and multiple risk factors for mortality including age, sex and deprivation have been identified. This study aimed to identify which individual indicators of the Scottish Index of Multiple Deprivation (SIMD), an area-based deprivation index, were predictive of mortality.
METHODS
This was a prospective cohort study of anonymised electronic health records of 710 consecutive patients hospitalised with Covid-19 disease between March and June 2020 in the Lothian Region of Southeast Scotland. Data sources included automatically extracted data from national electronic platforms and manually extracted data from individual admission records. Exposure variables of interest were SIMD quintiles and 12 indicators of deprivation deemed clinically relevant selected from the SIMD. Our primary outcome was mortality. Age and sex adjusted univariable and multivariable analyses were used to determine measures of association between exposures of interest and the primary outcome.
RESULTS
After adjusting for age and sex, we found an increased risk of mortality in the more deprived SIMD quintiles 1 and 3 (OR 1.75, CI 0.99-3.08, p = 0.053 and OR 2.17, CI 1.22-3.86, p = 0.009, respectively), but this association was not upheld in our multivariable model containing age, sex, Performance Status and clinical parameters of severity at admission. Of the 12 pre-selected indicators of deprivation, two were associated with greater mortality in our multivariable analysis: income deprivation rate categorised by quartile (Q4 (most deprived): 2.11 (1.20-3.77) p = 0.011)) and greater than expected hospitalisations due to alcohol per SIMD data zone (1.96 (1.28-3.00) p = 0.002)).
CONCLUSIONS
SIMD as an aggregate measure of deprivation was not predictive of mortality in our cohort when other exposure measures were accounted for. However, we identified a two-fold increased risk of mortality in patients residing in areas with greater income-deprivation and/or number of hospitalisations due to alcohol. In areas where aggregate measures fail to capture pockets of deprivation, exploring the impact of specific SIMD indicators may be helpful in targeting resources to residents at risk of poorer outcomes from Covid-19.
Identifiants
pubmed: 37794428
doi: 10.1186/s12939-023-02017-y
pii: 10.1186/s12939-023-02017-y
pmc: PMC10552319
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
205Subventions
Organisme : Wellcome Trust
Pays : United Kingdom
Organisme : Wellcome Trust
ID : I211116-1060
Pays : United Kingdom
Investigateurs
Atul Anand
(A)
Kathy Harrison
(K)
Ally Hume
(A)
Catriona Waugh
(C)
Catherine Stables
(C)
Chloe Brook
(C)
Chris Duncan
(C)
David Homan
(D)
Erin Cadger
(E)
Ioanna Lampaki
(I)
Jennifer Daub
(J)
Jilly McKay
(J)
Neil Murray
(N)
Ronnie Harkess
(R)
Shedrack Ezu
(S)
Sophie McCall
(S)
Stela McLachlan
(S)
Alastair Thomson
(A)
Alistair Stewart
(A)
Daniella Ene
(D)
Hazel Neilson
(H)
Juergen Caris
(J)
Maria McMenemy
(M)
Nazir Lone
(N)
Nicola Rigglesford
(N)
Paul Schofield
(P)
Sophie David
(S)
Stephen Young
(S)
Tracey McKinley
(T)
Tracey Rapson
(T)
Anna K Jamieson
(AK)
Arjuna A Sivakumaran
(AA)
Arun Parajuli
(A)
Ed Whittaker
(E)
Emma K Watson
(EK)
Ha Bao Trung Le
(HBT)
Hannah M M Preston
(HMM)
Jason Yang
(J)
John P Kelly
(JP)
Jonathan Wubetu
(J)
Julia Guerrero Enriquez
(JG)
Kathryn A W Knight
(KAW)
Louisa R Cary
(LR)
Oscar C N Maltby
(OCN)
Rosie Callender
(R)
Sarah H Goodwin
(SH)
Thomas H Clouston
(TH)
Thomas J McCormick
(TJ)
XinYi Ng
(X)
Zaina Sharif
(Z)
Anoop Shah
(A)
Colan Mehaffey
(C)
Ken Lee
(K)
Laura Woods-Dunlop
(L)
Michael Gray
(M)
Nicholas Mills
(N)
Pamela Linksted
(P)
Peter Cairns
(P)
Rob Baxter
(R)
Stephen Lavenberg
(S)
Susan Buckingham
(S)
Informations de copyright
© 2023. BioMed Central Ltd., part of Springer Nature.
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