Abstract
The COVID-19 pandemic has disproportionately impacted the physical and mental health, and the economic stability, of specific population subgroups in different ways, deepening existing disparities. Essential workers have faced the greatest risk of exposure to COVID-19; women have been burdened by caretaking responsibilities; and rural residents have experienced healthcare access barriers. Each of these factors did not occur on their own. While most research has so far focused on individual factors related to COVID-19 disparities, few have explored the complex relationships between the multiple components of COVID-19 vulnerabilities. Using structural equation modeling on a sample of United States (U.S.) workers (N = 2800), we aimed to 1) identify factor clusters that make up specific COVID-19 vulnerabilities, and 2) explore how these vulnerabilities affected specific subgroups, specifically essential workers, women and rural residents. We identified 3 COVID-19 vulnerabilities: financial, mental health, and healthcare access; 9 out of 10 respondents experienced one; 15% reported all three. Essential workers [standardized coefficient (β) = 0.23; unstandardized coefficient (B) = 0.21, 95% CI = 0.17, 0.24] and rural residents (β = 0.13; B = 0.12, 95% CI = 0.09, 0.16) experienced more financial vulnerability than non-essential workers and non-rural residents, respectively. Women (β = 0.22; B = 0.65, 95% CI = 0.65, 0.74) experienced worse mental health than men; whereas essential workers reported better mental health (β = -0.08; B = -0.25, 95% CI = -0.38, -0.13) than other workers. Rural residents (β = 0.09; B = 0.15, 95% CI = 0.07, 0.24) experienced more healthcare access barriers than non-rural residents. Findings highlight how interrelated financial, mental health, and healthcare access vulnerabilities contribute to the disproportionate COVID-19-related burden among U.S. workers. Policies to secure employment conditions, including fixed income and paid sick leave, are urgently needed to mitigate pandemic-associated disparities.
Highlights
The coronavirus disease (COVID-19) pandemic has claimed a devastating toll on people’s physical and mental health [1, 2] and caused social and economic hardship both globally and in the United States (U.S.) [3]
Our analysis indicates that three distinct vulnerabilities emerged during the COVID-19 pandemic among U.S working adults: financial, mental health, and access to care
Study findings underscore the importance of a systems thinking approach to understanding COVID-19-related disparities experienced by U.S workers, and highlight how interrelated financial, mental health, and healthcare access vulnerabilities may be contributing to the disproportionate COVID-19-related burden experienced by specific subpopulations
Summary
The coronavirus disease (COVID-19) pandemic has claimed a devastating toll on people’s physical and mental health [1, 2] and caused social and economic hardship both globally and in the United States (U.S.) [3]. The COVID-19 pandemic has disproportionately affected the working poor and exacerbated existing socioeconomic and health disparities. Essential workers, which include frontline healthcare workers and others who must perform work-related duties onsite (e.g., first responders, grocery store workers, agricultural workers) [10], are at increased risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and face a significant burden of economic insecurity and job precarity (e.g., low wages, variable income, no paid sick leave, no health insurance), which could lead to poor mental health [4, 11]. The overall prevalence of mental illness is higher among women (24.5%) than among men (16.3%) [15]; economic insecurity and increased care burden may contribute to the worsening of sex-based mental health disparities [16]
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