{
  "abstract": "Background Socially and economically disadvantaged populations were disproportionately affected by COVID-19, but it remains unclear whether and how variants of concern moderated the associations between social determinants of health and COVID-19 outcomes.Methods We aggregated cases by week and health region (n=231) from 1 January 2021 to 27 February 2022, covering four major variants of concern waves–Alpha, Gamma, Delta and Omicron–in British Columbia, the third most populated province in Canada. We constructed a region-specific, continuous socioeconomic index (SI) in which a one-unit increase represents a 10% increase in socioeconomic status across the health region. We fitted Bayesian spatiotemporal models on four COVID-19 outcomes separately: cases, hospitalisations, intensive care unit admissions and deaths, adjusting for interaction between SI and variants of concern, percentage male and vaccine coverage. We estimated the marginal rate ratio (RR) between SI and the outcomes by variants of concern.Results Overall, Alpha, Gamma and Delta heightened the associations between SI and all outcomes. The marginal RR between SI and cases was 0.96 (95% credible interval (CrI): 0.93, 1.00) in the absence of variants of concern, 0.93 (95% CrI: 0.88, 0.97) in the presence of Alpha, 0.93 (95% CrI: 0.88, 0.98) for Gamma and 0.90 (95% CrI: 0.87, 0.93) for Delta. Omicron reversed the direction of SI’s association with cases (RR: 1.03, 95% CrI: 0.99, 1.07) and dampened the associations with other outcomes.Conclusions Variants of concern generally widened the socioeconomic disparities in COVID-19 outcomes. Tailoring and optimising pandemic preparedness and response measures to the specific needs of disadvantaged populations is vital for reducing the additional disease burden experienced by some communities in British Columbia and across Canada.",
  "authors": [
    {
      "affiliations": [
        "BC Centre for Disease Control, Vancouver, British Columbia, Canada"
      ],
      "name": "Fanyu Xiu"
    },
    {
      "affiliations": [
        "BC Centre for Disease Control, Vancouver, British Columbia, Canada",
        "Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada"
      ],
      "name": "Michael A Irvine"
    },
    {
      "affiliations": [
        "BC Centre for Disease Control, Vancouver, British Columbia, Canada",
        "Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada"
      ],
      "name": "Natalie Prystajecky"
    },
    {
      "affiliations": [
        "BC Centre for Disease Control, Vancouver, British Columbia, Canada",
        "Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada"
      ],
      "name": "Linda Hoang"
    },
    {
      "affiliations": [
        "MAP-Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Ontario, Canada"
      ],
      "name": "Linwei Wang"
    },
    {
      "affiliations": [
        "MAP-Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Ontario, Canada",
        "Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada",
        "Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada",
        "Public Health Ontario, Toronto, Ontario, Canada"
      ],
      "name": "Sharmistha Mishra"
    },
    {
      "affiliations": [
        "Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada",
        "Public Health Ontario, Toronto, Ontario, Canada",
        "Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada",
        "Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada"
      ],
      "name": "Beate Sander"
    },
    {
      "affiliations": [
        "Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA"
      ],
      "name": "Stefan Baral"
    },
    {
      "affiliations": [
        "BC Centre for Disease Control, Vancouver, British Columbia, Canada",
        "Centre for Advancing Health Outcomes, St Paul’s Hospital, Vancouver, British Columbia, Canada",
        "School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada"
      ],
      "name": "Naveed Z Janjua"
    },
    {
      "affiliations": [
        "BC Centre for Disease Control, Vancouver, British Columbia, Canada",
        "School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada"
      ],
      "name": "Hind Sbihi"
    }
  ],
  "title": "Associations between social determinants of health and COVID-19 outcomes by variants of concern: a Bayesian spatiotemporal analysis",
  "uid": "3d892216-c75a-559a-ad6b-2f6600cb128c"
}