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From test to rest: evaluating socioeconomic differences along the COVID-19 care pathway in the Netherlands

Author

Listed:
  • Iris Meulman

    (Tilburg University
    National Institute for Public Health and the Environment)

  • Ellen Uiters

    (National Institute for Public Health and the Environment)

  • Mariëlle Cloin

    (Tilburg University)

  • Jeroen Struijs

    (National Institute for Public Health and the Environment
    Leiden University Medical Center–Health Campus The Hague)

  • Johan Polder

    (Tilburg University
    National Institute for Public Health and the Environment)

  • Niek Stadhouders

    (Radboud University Medical Center)

Abstract

Introduction The COVID-19 pandemic exacerbated healthcare needs and caused excess mortality, especially among lower socioeconomic groups. This study describes the emergence of socioeconomic differences along the COVID-19 pathway of testing, healthcare use and mortality in the Netherlands. Methodology This retrospective observational Dutch population-based study combined individual-level registry data from June 2020 to December 2020 on personal socioeconomic characteristics, COVID-19 administered tests, test results, general practitioner (GP) consultations, hospital admissions, Intensive Care Unit (ICU) admissions and mortality. For each outcome measure, relative differences between income groups were estimated using log-link binomial regression models. Furthermore, regression models explained socioeconomic differences in COVID-19 mortality by differences in ICU/hospital admissions, test administration and test results. Results Among the Dutch population, the lowest income group had a lower test probability (RR = 0.61) and lower risk of testing positive (RR = 0.77) compared to the highest income group. However, among individuals with at least one administered COVID-19 test, the lowest income group had a higher risk of testing positive (RR = 1.40). The likelihood of hospital admissions and ICU admissions were higher for low income groups (RR = 2.11 and RR = 2.46, respectively). The lowest income group had an almost four times higher risk of dying from COVID-19 (RR = 3.85), which could partly be explained by a higher risk of hospitalization and ICU admission, rather than differences in test administration or result. Discussion Our findings indicated that socioeconomic differences became more pronounced at each step of the care pathway, culminating to a large gap in mortality. This underlines the need for enhancing social security and well-being policies and incorporation of health equity in pandemic preparedness plans.

Suggested Citation

  • Iris Meulman & Ellen Uiters & Mariëlle Cloin & Jeroen Struijs & Johan Polder & Niek Stadhouders, 2024. "From test to rest: evaluating socioeconomic differences along the COVID-19 care pathway in the Netherlands," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 25(9), pages 1581-1594, December.
    • Handle: RePEc:spr:eujhec:v:25:y:2024:i:9:d:10.1007_s10198-024-01680-4
    DOI: 10.1007/s10198-024-01680-4
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    References listed on IDEAS

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    1. Sven Drefahl & Matthew Wallace & Eleonora Mussino & Siddartha Aradhya & Martin Kolk & Maria Brandén & Bo Malmberg & Gunnar Andersson, 2020. "A population-based cohort study of socio-demographic risk factors for COVID-19 deaths in Sweden," Nature Communications, Nature, vol. 11(1), pages 1-7, December.
    2. repec:dau:papers:123456789/10510 is not listed on IDEAS
    3. Brea L Perry & Brian Aronson & Ashley F Railey & Christina Ludema, 2021. "If you build it, will they come? Social, economic, and psychological determinants of COVID-19 testing decisions," PLOS ONE, Public Library of Science, vol. 16(7), pages 1-13, July.
    4. Thunström, Linda & Ashworth, Madison & Shogren, Jason F. & Newbold, Stephen & Finnoff, David, 2021. "Testing for COVID-19: willful ignorance or selfless behavior?," Behavioural Public Policy, Cambridge University Press, vol. 5(2), pages 135-152, April.
    5. Xinyang Li & Xianrui Zhong & Yongbo Wang & Xiantao Zeng & Ting Luo & Qing Liu, 2021. "Clinical determinants of the severity of COVID-19: A systematic review and meta-analysis," PLOS ONE, Public Library of Science, vol. 16(5), pages 1-21, May.
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    More about this item

    Keywords

    Socioeconomic inequality; COVID-19 testing; COVID-19 healthcare utilization; COVID-19 mortality;
    All these keywords.

    JEL classification:

    • I14 - Health, Education, and Welfare - - Health - - - Health and Inequality
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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