Social and Policy Determinants of COVID-19 Infection Across 23 Countries: An Ecological Study
- Author:
Kyungsik KIM
1
;
Young-Do JEUNG
;
Jeoungbin CHOI
;
Sue K. PARK
Author Information
- Publication Type:Original Article
- From:Journal of Preventive Medicine and Public Health 2022;55(2):144-152
- CountryRepublic of Korea
- Language:English
-
Abstract:
Objectives:This study aimed to identify the social and policy determinants of coronavirus disease 2019 (COVID-19) infection across 23 countries.
Methods:COVID-19 indicators (incidence, mortality, and fatality) for each country were calculated by direct and indirect standardization. Multivariable regression analyses were used to identify the social and policy determinants of COVID-19 infection.
Results:A higher number of doctors per population was related to lower incidence, mortality, and fatality rates of COVID-19 in 23 countries (β=-0.672, -0.445, and -0.564, respectively). The number of nurses/midwives per population was associated with lower mortality and fatality rates of COVID-19 in 23 countries (β=-0.215 and -0.372, respectively). Strengthening of policy restriction indicators, such as restrictions of public gatherings, was related to lower COVID-19 incidence (β=-0.423). A national Bacillus Calmette–Guérin vaccination policy conducted among special groups or in the past was associated with a higher incidence of COVID-19 in 23 countries (β=0.341). The proportion of the elderly population (aged over 70 years) was related to higher mortality and fatality rates (β=0.209 and 0.350, respectively), and income support was associated with mortality and fatality rates (β=-0.362 and -0.449, respectively).
Conclusions:These findings do not imply causality because this was a country-based correlation study. However, COVID-19 transmission can be influenced by social and policy determinants such as integrated health systems and policy responses to COVID-19. Various social and policy determinants should be considered when planning responses to COVID-19.
