Socioeconomic Conditions and Severe COVID-19 Outcomes: The Role of Chronic Stress and Health Behaviors

Despite extensive research on COVID-19, few scientific contributions have explored the role of health behaviors and chronic stress and their socioeconomic determinants in exacerbating the health effects of COVID-19. This paper aims to review mechanisms and strategies that explain how socioeconomic conditions contribute to severe COVID-19 outcomes through chronic stress and biological mechanisms such as immune responses, systemic inflammation, gut microbiota dysbiosis and impaired antiviral defences. It also examines how these effects are exacerbated by unhealthy behaviors (e.g. poor diet, smoking, alcohol consumption, physical inactivity, and sleep deprivation) that are more prevalent in populations experiencing higher levels of chronic stress and living in poorer socioeconomic circumstances. A conceptual framework is proposed to explain the multiple links between policies, socioeconomic conditions, chronic stress, and the mediating effects of behavioral and biological mechanisms in exacerbating the health effects of COVID-19. Interventions to reduce the impact of these risk factors must address both individual-level behaviors and structural determinants of health. This paper highlights the importance of using complementary strategies to vaccination and prevention when tackling COVID-19, based on a syndemic approach that considers the interplay between biological, behavioral, and socioeconomic factors. Policies that reduce poverty and financial strain and improve access to basic needs such as housing, healthy food, safe jobs, education, and healthcare, while promoting healthier lifestyles by addressing their structural determinants, can significantly reduce the health burden of future pandemics such as COVID-19.