Socioeconomic position and SARS-CoV-2 infections: seroepidemiological findings from a German nationwide dynamic cohort
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Abstract
Evidence on the relationship between socioeconomic position (SEP) and infections with SARS-CoV-2 is still limited as most of the available studies are ecological in nature. This is the first German nationwide study to examine differences in the risk of SARS-CoV-2 infections according to SEP at the individual level.
Methods
The ‘CORONA-MONITORING bundesweit’ (RKI-SOEP) study is a seroepidemiological survey among a dynamic cohort of the German adult population (n=15 122; October 2020–February 2021). Dried blood samples were tested for SARS-CoV-2 antibodies and oral-nasal swabs for viral RNA. SEP was measured by education and income. Robust logistic regression was used to examine adjusted associations of SARS-CoV-2 infections with SEP.
Results
288 participants were seropositive, PCR positive or self-reported a previous laboratory-confirmed SARS-CoV-2 infection. The adjusted odds of SARS-CoV-2 infection were 1.87-fold (95% CI 1.06 to 3.29) higher among low-educated than highly educated adults. Evidence was weaker for income differences in infections (OR=1.65; 95% CI 0.89 to 3.05). Highly educated adults had lower odds of undetected infection.
Conclusion
The results indicate an increased risk of SARS-CoV-2 infection in low-educated groups. To promote health equity in the pandemic and beyond, social determinants should be addressed more in infection protection and pandemic planning.
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SciScore for 10.1101/2021.06.21.21259001: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics Field Sample Permit: Both specimens were collected by the participants themselves using CE-certified sample collection and submission kits sent by post along with written, pictorial, and video instructions. Sex as a biological variable not detected. Randomization Study design and data: The ‘CORONA-MONITORING bundesweit’ study (RKI-SOEP study) is based on the nationwide population-based random samples administered by the German Socio-Economic Panel (SOEP), a dynamic cohort from Germany’s resident population in private households [7]. Blinding not detected. Power Analysis not detected. Table 2: Resources
Antibodies Sentences Resources Measures and definitions: We used three metrics of SARS-CoV-2 … SciScore for 10.1101/2021.06.21.21259001: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics Field Sample Permit: Both specimens were collected by the participants themselves using CE-certified sample collection and submission kits sent by post along with written, pictorial, and video instructions. Sex as a biological variable not detected. Randomization Study design and data: The ‘CORONA-MONITORING bundesweit’ study (RKI-SOEP study) is based on the nationwide population-based random samples administered by the German Socio-Economic Panel (SOEP), a dynamic cohort from Germany’s resident population in private households [7]. Blinding not detected. Power Analysis not detected. Table 2: Resources
Antibodies Sentences Resources Measures and definitions: We used three metrics of SARS-CoV-2 infection based on combinations of the following: seropositivity for SARS-CoV-2 IgG antibodies from dried blood samples (Euroimmun SARS-CoV-2-S1 IgG-ELISA; cut-off adapted for dried blood spot testing: ratio ≥ 0.94 [8]), a positive SARS-CoV-2-PCR test result in the study, and any self-reported SARS-CoV-2-positive throat swab laboratory test conducted prior to study participation. SARS-CoV-2 IgGsuggested: NoneSoftware and Algorithms Sentences Resources Standard error estimation was performed using Stata’s survey data commands (version 17.0, StataCorp LLC, College Station, TX, USA) accounting for weighting and household clustering. StataCorpsuggested: (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:An important limitation to be considered is that the sample was restricted to residents in private households. Institutionalised people, such as nursing home residents or people living in shared accommodations for homeless people, migrant workers or asylum seekers, are not represented by the sample. Assuming increased infection risks in these groups, this study may have underestimated the nationwide prevalence of SARS-CoV-2 and socioeconomic differences in infections. Our findings support evidence from earlier pandemics of viral respiratory pathogens, such as influenza, suggesting higher levels of viral exposure in low-SEP settings [6]. Consistent with our findings, higher levels of SARS-CoV-2 infections in low-educated individuals have been found in the UK Biobank [9]. However, individual-level nationwide findings on SEP differences in SARS-CoV-2 infections during the pandemic are still scarce and sometimes contrary [10]. Important mediators in the relationship between education and infections may be occupational working conditions. People in medium-to low-skilled occupations such as nursing, retailing, food production or logistics, had few opportunities to reduce occupational contact and mobility by working remotely during the pandemic, and are associated with more contact and proximity with others. Our findings indicate an increased risk of SARS-CoV-2 infection in educationally disadvantaged groups and suggest higher detection of infections among highly educated adults. In...
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.
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- No protocol registration statement was detected.
Results from scite Reference Check: We found no unreliable references.
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