Abstract
BackgroundPandemic mortality rates in 1918 and in 2009 were highest among those with the lowest socioeconomic status (SES). Despite this, low SES groups are not included in the list of groups prioritized for pandemic vaccination, and the ambition to reduce social inequality in health does not feature in international and national pandemic preparedness plans. We describe plans for a systematic review and meta-analysis of the association between SES and pandemic outcomes during the last five pandemics.MethodThe planned review will cover studies of pandemic influenza that report associations between morbidity, hospitalization, or mortality with socioeconomic factors such as education and income. The review will include published studies in the English, Danish, Norwegian, and Swedish languages, regardless of geographical location. Relevant records were identified through systematic literature searches in MEDLINE, Embase, Cinahl, SocIndex, Scopus, and Web of Science. Reference lists of relevant known studies will be screened and experts in the field consulted in order to identify other additional sources. Two investigators will independently screen and select studies, and discrepancies will be resolved through discussion until consensus is reached. Covidence will be used. Results will be summarized narratively and using three meta-analytic strategies: coefficients expressing the difference between the highest and lowest socioeconomic groups reported will be pooled using (a) fixed and random effects meta-analysis where studies involve similar outcome and exposure measures and (b) meta-regression where studies involve similar outcome measures. In addition, we will attempt to use all reported estimates for SES differences in (c) a Bayesian meta-analysis to estimate the underlying SES gradient and how it differs by outcome and exposure measure.DiscussionThis study will provide the first systematic review of research on the relation between SES and pandemic outcomes. The findings will be relevant for health policy in helping to assess whether people of low socioeconomic status should be prioritized for vaccines in preparedness plans for pandemic influenza. The review will also contribute to the research literature by providing pooled estimates of effect sizes as inputs into power calculations of future studies.Systematic review registrationPROSPERO 87922
Highlights
DiscussionThis study will provide the first systematic review of research on the relation between socioeconomic status (SES) and pandemic outcomes
Reducing social inequality in health is a core aim of international policies and health work, but a recent review of international and national pandemic preparedness plans finds this perspective lacking in this policy area [1]
The findings will be relevant for health policy in helping to assess whether people of low socioeconomic status should be prioritized for vaccines in preparedness plans for pandemic influenza
Summary
To the best of our knowledge, our review will be the first to review systematically the evidence for a link between socioeconomic status and pandemic outcomes. If socioeconomic risk factors are shown to be important in explaining the variation in pandemic outcomes above and beyond biomedical risk factors, influenza pandemic preparedness plans should include discussion regarding how to reduce social inequalities in pandemic outcomes, e.g., by recommending vaccination to certain households with below poverty income or people living in a designated poverty area. If socioeconomic risk factors cannot explain the association between the traditional biomedical risk factors and pandemic outcomes, pandemic preparedness plans do not need to be changed.
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