The intersection of age, sex, race and socio-economic status in COVID-19 hospital admissions and deaths in South Africa (with corrigendum)

Waasila Jassat; Lovelyn Ozougwu; Shehnaz Munshi; Caroline Mudara; Caroline Vika; Tracy Arendse; Maureen Masha; Richard Welch; Nevashan Govender; Joy Ebonwu; Michelle Groome; Andre Joseph; Shabir A. Madhi; Cheryl Cohen; Lucille Blumberg

doi:10.17159/sajs.2022/13323

Authors

Waasila Jassat 1.National Institute for Communicable Diseases (NICD), National Health Laboratory Service (NHLS), Johannesburg, South Africa; 2.Right to Care, Pretoria, South Africa https://orcid.org/0000-0003-4279-3056
Lovelyn Ozougwu National Institute for Communicable Diseases (NICD), National Health Laboratory Service (NHLS), Johannesburg, South Africa https://orcid.org/0000-0002-9120-9410
Shehnaz Munshi School of Public Health, University of the Witwatersrand, Johannesburg, South Africa https://orcid.org/0000-0002-6508-2313
Caroline Mudara National Institute for Communicable Diseases (NICD), National Health Laboratory Service (NHLS), Johannesburg, South Africa
Caroline Vika National Institute for Communicable Diseases (NICD), National Health Laboratory Service (NHLS), Johannesburg, South Africa
Tracy Arendse National Institute for Communicable Diseases (NICD), National Health Laboratory Service (NHLS), Johannesburg, South Africa
Maureen Masha 1.National Institute for Communicable Diseases (NICD), National Health Laboratory Service (NHLS), Johannesburg, South Africa; 2.Right to Care, Pretoria, South Africa
Richard Welch National Institute for Communicable Diseases (NICD), National Health Laboratory Service (NHLS), Johannesburg, South Africa
Nevashan Govender National Institute for Communicable Diseases (NICD), National Health Laboratory Service (NHLS), Johannesburg, South Africa
Joy Ebonwu National Institute for Communicable Diseases (NICD), National Health Laboratory Service (NHLS), Johannesburg, South Africa https://orcid.org/0000-0002-1329-7785
Michelle Groome 1.National Institute for Communicable Diseases (NICD), National Health Laboratory Service (NHLS), Johannesburg, South Africa; 2.School of Pathology, University of the Witwatersrand, Johannesburg, South Africa https://orcid.org/0000-0001-5893-3725
Andre Joseph Life Healthcare, Johannesburg, South Africa
Shabir A. Madhi 1.South African Medical Research Council (SAMRC) Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa; 2.African Leadership in Vaccinology Expertise (ALIVE), University of the Witwatersrand, Johannesburg, South Africa https://orcid.org/0000-0002-7629-0636
Cheryl Cohen 1.National Institute for Communicable Diseases (NICD), National Health Laboratory Service (NHLS), Johannesburg, South Africa; 2.School of Public Health, University of the Witwatersrand, Johannesburg, South Africa https://orcid.org/0000-0003-0376-2302
Lucille Blumberg 1.National Institute for Communicable Diseases (NICD), National Health Laboratory Service (NHLS), Johannesburg, South Africa; 2.Right to Care, Pretoria, South Africa https://orcid.org/0000-0002-2828-7678

DOI:

https://doi.org/10.17159/sajs.2022/13323

Keywords:

COVID-19, hospitalisation, mortality, race, age, sex, socio-economic status

Abstract

Older age, male sex, and non-white race have been reported to be risk factors for COVID-19 mortality. Few studies have explored how these intersecting factors contribute to COVID-19 outcomes. This study aimed to compare demographic characteristics and trends in SARS-CoV-2 admissions and the health care they received. Hospital admission data were collected through DATCOV, an active national COVID-19 surveillance programme. Descriptive analysis was used to compare admissions and deaths by age, sex, race, and health sector as a proxy for socio-economic status. COVID-19 mortality and healthcare utilisation were compared by race using random effect multivariable logistic regression models. On multivariable analysis, black African patients (adjusted OR [aOR] 1.3, 95% confidence interval [CI] 1.2, 1.3), coloured patients (aOR 1.2, 95% CI 1.1, 1.3), and patients of Indian descent (aOR 1.2, 95% CI 1.2, 1.3) had increased risk of in-hospital COVID-19 mortality compared to white patients; and admission in the public health sector (aOR 1.5, 95% CI 1.5, 1.6) was associated with increased risk of mortality compared to those in the private sector. There were higher percentages of COVID-19 hospitalised individuals treated in ICU, ventilated, and treated with supplemental oxygen in the private compared to the public sector. There were increased odds of non-white patients being treated in ICU or ventilated in the private sector, but decreased odds of black African patients being treated in ICU (aOR 0.5; 95% CI 0.4, 0.5) or ventilated (aOR 0.5; 95% CI 0.4, 0.6) compared to white patients in the public sector. These findings demonstrate the importance of collecting and analysing data on race and socio-economic status to ensure that disease control measures address the most vulnerable populations affected by COVID-19.

Significance:

These findings demonstrate the importance of collecting data on socio-economic status and race alongside age and sex, to identify the populations most vulnerable to COVID-19.
This study allows a better understanding of the pre-existing inequalities that predispose some groups to poor disease outcomes and yet more limited access to health interventions.
Interventions adapted for the most vulnerable populations are likely to be more effective.
The national government must provide efficient and inclusive non-discriminatory health services, and urgently improve access to ICU, ventilation and oxygen in the public sector.
Transformation of the healthcare system is long overdue, including narrowing the gap in resources between the private and public sectors.