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Unequal burden of COVID-19 in Hungary: a geographical and socioeconomic analysis of the second wave of the pandemic
BMJ Global Health ( IF 7.1 ) Pub Date : 2021-09-01 , DOI: 10.1136/bmjgh-2021-006427
Beatrix Oroszi 1 , Attila Juhász 2 , Csilla Nagy 2 , Judit Krisztina Horváth 1 , Martin McKee 3 , Róza Ádány 4, 5
Affiliation  

Introduction We describe COVID-19 morbidity, mortality, case fatality and excess death in a country-wide study of municipalities in Hungary, exploring the association with socioeconomic status. Methods The spatial distribution of morbidity, mortality and case fatality was mapped using hierarchical Bayesian smoothed indirectly standardised ratios. Indirectly standardised ratios were used to evaluate the association between deprivation and the outcome measures. We looked separately at morbidity and mortality in the 10 districts with the highest and 10 districts with the lowest share of Roma population. Results Compared with the national average, the relative incidence of cases was 30%–36% lower in the most deprived quintile but the relative mortality and case fatality were 27%–32% higher. Expressed as incidence ratios relative to the national average, the most deprived municipalities had a relative incidence ratio of 0.64 (CI: 0.62 to 0.65) and 0.70 (CI: 0.69 to 0.72) for males and females, respectively. The corresponding figures for mortality were 1.32 (CI: 1.20 to 1.44) for males and 1.27 (CI: 1.16 to 1.39) for females and for case fatality 1.27 (CI: 1.16 to 1.39) and 1.32 (CI: 1.20 to 1.44) for males and females, respectively. The excess death rate (per 100 000) increased with deprivation levels (least deprived: 114.12 (CI: 108.60 to 119.84) and most deprived: 158.07 (CI: 149.30 to 167.23)). The 10 districts where Roma formed the greatest share of the population had an excess mortality rate 17.46% higher than the average for the most deprived quintile. Conclusions Those living in more deprived municipalities had a lower risk of being identified as a confirmed COVID-19 case but had a higher risk of death. An inverse association between trends in morbidity and mortality by socioeconomic conditions should be a cause for concern and points to the need for responses, including those involving vaccination, to pay particular attention to inequalities and their causes. Extracted data sheets and data dictionary will be made available immediately after publicationof this Article upon request to the corresponding author Róza Ádány DSc. These data sheetswill be shared with researchers who provide a methodologically sound proposal, after theauthors' review of requests. Requesters will need to sign a data access agreement.

中文翻译:

匈牙利 COVID-19 的不平等负担:对第二波大流行的地理和社会经济分析

简介 我们在匈牙利各城市的全国研究中描述了 COVID-19 发病率、死亡率、病死率和超额死亡,探索与社会经济地位的关联。方法 使用分层贝叶斯平滑间接标准化比率绘制发病率、死亡率和病死率的空间分布图。间接标准化比率用于评估剥夺与结果措施之间的关联。我们分别研究了罗姆人人口比例最高的 10 个地区和罗姆人人口比例最低的 10 个地区的发病率和死亡率。结果 与全国平均水平相比,最贫困的五分之一人群的相对发病率低 30% 至 36%,但相对死亡率和病死率高 27% 至 32%。以相对于全国平均水平的发病率表示,最贫困的城市男性和女性的相对发病率分别为 0.64(CI:0.62 至 0.65)和 0.70(CI:0.69 至 0.72)。男性的相应死亡率为 1.32(CI:1.20 至 1.44),女性为 1.27(CI:1.16 至 1.39),男性的病死率为 1.27(CI:1.16 至 1.39)和 1.32(CI:1.20 至 1.44)和女性,分别。超额死亡率(每 100 000 人)随着剥夺程度的增加而增加(剥夺程度最低:114.12(CI:108.60 至 119.84),剥夺程度最高:158.07(CI:149.30 至 167.23))。罗姆人占人口比例最大的 10 个地区的超额死亡率比最贫困的五分之一人口的平均水平高 17.46%。结论 生活在较贫困城市的人被确定为 COVID-19 确诊病例的风险较低,但死亡风险较高。社会经济条件导致的发病率和死亡率趋势之间的负相关应该引起关注,并指出需要采取应对措施,包括涉及疫苗接种的应对措施,以特别注意不平等及其原因。提取的数据表和数据字典将在本文发表后根据相应作者 Róza Ádány DSc 的要求立即提供。在作者审查请求后,这些数据表将与提供方法论合理建议的研究人员共享。请求者需要签署数据访问协议。社会经济条件导致的发病率和死亡率趋势之间的负相关应该引起关注,并指出需要采取应对措施,包括涉及疫苗接种的应对措施,以特别注意不平等及其原因。提取的数据表和数据字典将在本文发表后根据相应作者 Róza Ádány DSc 的要求立即提供。在作者审查请求后,这些数据表将与提供方法论合理建议的研究人员共享。请求者需要签署数据访问协议。社会经济条件导致的发病率和死亡率趋势之间的负相关应该引起关注,并指出需要采取应对措施,包括涉及疫苗接种的应对措施,以特别注意不平等及其原因。提取的数据表和数据字典将在本文发表后根据相应作者 Róza Ádány DSc 的要求立即提供。在作者审查请求后,这些数据表将与提供方法论合理建议的研究人员共享。请求者需要签署数据访问协议。特别注意不平等现象及其原因。提取的数据表和数据字典将在本文发表后根据相应作者 Róza Ádány DSc 的要求立即提供。在作者审查请求后,这些数据表将与提供方法论合理建议的研究人员共享。请求者需要签署数据访问协议。特别注意不平等现象及其原因。提取的数据表和数据字典将在本文发表后根据相应作者 Róza Ádány DSc 的要求立即提供。在作者审查请求后,这些数据表将与提供方法论合理建议的研究人员共享。请求者需要签署数据访问协议。
更新日期:2021-09-13
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