A cross-sectional study of socioeconomic status and treatment interruption among Japanese workers during the COVID-19 pandemic

  1. Kenji Fujimoto
  2. Tomohiro Ishimaru
  3. Seiichiro Tateishi
  4. Tomohisa Nagata
  5. Mayumi Tsuji
  6. Hisashi Eguchi
  7. Akira Ogami
  8. Shinya Matsuda
  9. Yoshihisa Fujino
  10. for the CORoNaWork Project

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Abstract

Background

The COVID-19 pandemic has caused interruptions to chronic disease and non-emergency treatment. The purpose of this study is to examine which socioeconomic status groups are most at risk of treatment interruption.

Methods

This cross-sectional internet monitor study was conducted on December 22–26, 2020, when Japan experienced its third wave of COVID-19 infection. Out of a total of 33,302 participants in the survey, 9510 (5392 males and 4118 females) who responded that they required regular treatment or hospital visits were included in the analysis. A multilevel logistic model nested in the prefecture of residence was used to estimate the odds ratio (OR) for treatment disruption. We examined separate multivariate models for socioeconomic factors, health factors, and lifestyle factors.

Results

During a period of rapid COVID-19 infection, about 11% of Japanese workers who required regular treatment experienced interruptions to their treatment. The OR of treatment interruption associated with not being married compared to being married was 1.44; manual labor work compared to desk work was 1.30; loss of employment when the COVID-19 pandemic started and continued unemployment compared to being employed over the entire pandemic period was 1.62 and 2.57, respectively; and feeling financially unstable was 2.92.

Conclusion

Treatment interruption is a new health inequality brought about by COVID-19 with possible medium- and long-term effects, including excess mortality, morbidity, and productivity loss due to increased presenteeism. Efforts are needed to reduce treatment interruptions among workers who require regular treatment.

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  1. ScreenIT

    SciScore for 10.1101/2021.02.22.21252190: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variableOf these, 9510 (5392 males and 4118 females) who responded that they required regular treatment or hospital visits were included in the present analysis.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All analyses were conducted using Stata (Stata Statistical Software: Release 16; StataCorp LLC, TX, USA).
    StataCorp
    suggested: (Stata, RRID:SCR_012763)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Some limitations of this study warrant mention. First, we did not identify the reasons for treatment discontinuation. There are many possible explanations for why workers may discontinue treatment, including anxiety about COVID-19, financial reasons, lack of understanding of their disease, and lack of time to see a doctor. Second, we did not identify what diseases the workers were attempting to manage. Workers’ reasons for treatment interruption and the resulting effects are likely to be very different in the case of chronic diseases such as hypertension and diabetes, compared to cancer. Third, we did not inquire about the timing of treatment interruption; thus, we were unable to clarify the relationship between the timing of treatment interruption and changes in socioeconomic status, including employment and income, and lifestyle. In conclusion, during a period of rapid COVID-19 infection, about 11% of Japanese workers who required regular treatment experienced treatment interruption. Disadvantageous socioeconomic status, poor health, and unfavorable lifestyle habits were associated with treatment interruption. Thus, treatment interruption is a new health inequality brought about by COVID-19 with possible medium- and long-term effects, including excess mortality, morbidity, and productivity loss due to increased presenteeism. Efforts are needed to reduce treatment interruption among workers who require regular treatment.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2021.02.22.21252190v1 on medRxiv
  3. Version published to 10.1002/1348-9585.12232