Impacts of income inequality and the mediation role of reporting delays on COVID-19 deaths during 2020 and 2021 in Hong Kong: an observational study

Hsiang-Yu Yuan; Wing Hei Wong; Fatema Khairunnasa; Hung Chak Ho; Gary Ka-Ki Chung

doi:10.1136/bmjopen-2023-078838

Impacts of income inequality and the mediation role of reporting delays on COVID-19 deaths during 2020 and 2021 in Hong Kong: an observational study

Hsiang-Yu Yuan^*, Wing Hei Wong, Fatema Khairunnasa, Hung Chak Ho, Gary Ka-Ki Chung

^*Corresponding author for this work

Research output: Journal Publications and Reviews › RGC 21 - Publication in refereed journal › peer-review

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Abstract

Objective  To estimate the impacts of demographic factors and income disparities on the case fatality rate (CFR) of COVID-19 in Hong Kong, taking into account the influence of reporting delays (ie, the duration between symptom onset and case confirmation).
Design  Retrospective observational longitudinal study.
Participants  A total of 7406 symptomatic patients with residence information reported between 23 January 2020 and 2 October 2021.
Main outcome measures  The study examined the disparity in COVID-19 deaths associated with the factors such as age (≥65 vs 0–64 years old groups), gender and the income level of districts (low income vs non-low income). The severe reporting delay (>10 days) was considered as the mediator for mediation analysis. A Cox proportional hazards regression model was constructed.
Results  We found that CFR was 3.07% in the low-income region, twofold higher than 1.34% in the other regions. Although the severe reporting delay was associated with a hazard ratio (HR) of about 1.9, its mediation effect was only weakly present for age, but not for gender or income level. Hence, high CFR in Hong Kong was largely attributed to the direct effects of the elderly (HR 25.967; 95% CI 14.254 to 47.306) and low income (HR 1.558; 95% CI 1.122 to 2.164).
Conclusion  The disparity in COVID-19 deaths between income regions is not due to reporting delays, but rather to health inequities in Hong Kong. These risks may persist after the discontinuation of test-and-trace measures and extend to other high-threat respiratory pathogens. Urgent actions are required to identify vulnerable groups in low-income regions and understand the underlying causes of health inequities.

Original language	English
Article number	e078838
Journal	BMJ Open
Volume	14
Issue number	3
Online published	8 Mar 2024
DOIs	https://doi.org/10.1136/bmjopen-2023-078838
Publication status	Published - Mar 2024

Bibliographical note

Information for this record is supplemented by the author(s) concerned.

Funding

This research was funded by the City University of Hong Kong (7005748, 7005876 and 9610416), the General Research Fund (9043514), and the Health and Medical Research Fund (COVID190215).

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 1 No Poverty
SDG 10 Reduced Inequalities

Research Keywords

income inequality
Health inequality
disaster

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This full text is made available under CC-BY-NC 4.0. https://creativecommons.org/licenses/by-nc/4.0/

RGC Funding Information

RGC-funded

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title = "Impacts of income inequality and the mediation role of reporting delays on COVID-19 deaths during 2020 and 2021 in Hong Kong: an observational study",

abstract = "Objective To estimate the impacts of demographic factors and income disparities on the case fatality rate (CFR) of COVID-19 in Hong Kong, taking into account the influence of reporting delays (ie, the duration between symptom onset and case confirmation).Design Retrospective observational longitudinal study.Participants A total of 7406 symptomatic patients with residence information reported between 23 January 2020 and 2 October 2021.Main outcome measures The study examined the disparity in COVID-19 deaths associated with the factors such as age (≥65 vs 0–64 years old groups), gender and the income level of districts (low income vs non-low income). The severe reporting delay (>10 days) was considered as the mediator for mediation analysis. A Cox proportional hazards regression model was constructed.Results We found that CFR was 3.07% in the low-income region, twofold higher than 1.34% in the other regions. Although the severe reporting delay was associated with a hazard ratio (HR) of about 1.9, its mediation effect was only weakly present for age, but not for gender or income level. Hence, high CFR in Hong Kong was largely attributed to the direct effects of the elderly (HR 25.967; 95% CI 14.254 to 47.306) and low income (HR 1.558; 95% CI 1.122 to 2.164).Conclusion The disparity in COVID-19 deaths between income regions is not due to reporting delays, but rather to health inequities in Hong Kong. These risks may persist after the discontinuation of test-and-trace measures and extend to other high-threat respiratory pathogens. Urgent actions are required to identify vulnerable groups in low-income regions and understand the underlying causes of health inequities.{\textcopyright} Author(s) (or their employer(s)) 2024.",

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author = "Hsiang-Yu Yuan and Wong, {Wing Hei} and Fatema Khairunnasa and Ho, {Hung Chak} and Chung, {Gary Ka-Ki}",

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year = "2024",

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doi = "10.1136/bmjopen-2023-078838",

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T1 - Impacts of income inequality and the mediation role of reporting delays on COVID-19 deaths during 2020 and 2021 in Hong Kong

T2 - an observational study

AU - Yuan, Hsiang-Yu

AU - Wong, Wing Hei

AU - Khairunnasa, Fatema

AU - Ho, Hung Chak

AU - Chung, Gary Ka-Ki

N1 - Information for this record is supplemented by the author(s) concerned.

PY - 2024/3

Y1 - 2024/3

N2 - Objective To estimate the impacts of demographic factors and income disparities on the case fatality rate (CFR) of COVID-19 in Hong Kong, taking into account the influence of reporting delays (ie, the duration between symptom onset and case confirmation).Design Retrospective observational longitudinal study.Participants A total of 7406 symptomatic patients with residence information reported between 23 January 2020 and 2 October 2021.Main outcome measures The study examined the disparity in COVID-19 deaths associated with the factors such as age (≥65 vs 0–64 years old groups), gender and the income level of districts (low income vs non-low income). The severe reporting delay (>10 days) was considered as the mediator for mediation analysis. A Cox proportional hazards regression model was constructed.Results We found that CFR was 3.07% in the low-income region, twofold higher than 1.34% in the other regions. Although the severe reporting delay was associated with a hazard ratio (HR) of about 1.9, its mediation effect was only weakly present for age, but not for gender or income level. Hence, high CFR in Hong Kong was largely attributed to the direct effects of the elderly (HR 25.967; 95% CI 14.254 to 47.306) and low income (HR 1.558; 95% CI 1.122 to 2.164).Conclusion The disparity in COVID-19 deaths between income regions is not due to reporting delays, but rather to health inequities in Hong Kong. These risks may persist after the discontinuation of test-and-trace measures and extend to other high-threat respiratory pathogens. Urgent actions are required to identify vulnerable groups in low-income regions and understand the underlying causes of health inequities.© Author(s) (or their employer(s)) 2024.

AB - Objective To estimate the impacts of demographic factors and income disparities on the case fatality rate (CFR) of COVID-19 in Hong Kong, taking into account the influence of reporting delays (ie, the duration between symptom onset and case confirmation).Design Retrospective observational longitudinal study.Participants A total of 7406 symptomatic patients with residence information reported between 23 January 2020 and 2 October 2021.Main outcome measures The study examined the disparity in COVID-19 deaths associated with the factors such as age (≥65 vs 0–64 years old groups), gender and the income level of districts (low income vs non-low income). The severe reporting delay (>10 days) was considered as the mediator for mediation analysis. A Cox proportional hazards regression model was constructed.Results We found that CFR was 3.07% in the low-income region, twofold higher than 1.34% in the other regions. Although the severe reporting delay was associated with a hazard ratio (HR) of about 1.9, its mediation effect was only weakly present for age, but not for gender or income level. Hence, high CFR in Hong Kong was largely attributed to the direct effects of the elderly (HR 25.967; 95% CI 14.254 to 47.306) and low income (HR 1.558; 95% CI 1.122 to 2.164).Conclusion The disparity in COVID-19 deaths between income regions is not due to reporting delays, but rather to health inequities in Hong Kong. These risks may persist after the discontinuation of test-and-trace measures and extend to other high-threat respiratory pathogens. Urgent actions are required to identify vulnerable groups in low-income regions and understand the underlying causes of health inequities.© Author(s) (or their employer(s)) 2024.

KW - income inequality

KW - Health inequality

KW - disaster

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U2 - 10.1136/bmjopen-2023-078838

DO - 10.1136/bmjopen-2023-078838

M3 - RGC 21 - Publication in refereed journal

C2 - 38458781

SN - 2044-6055

VL - 14

JO - BMJ Open

JF - BMJ Open

IS - 3

M1 - e078838

ER -

Impacts of income inequality and the mediation role of reporting delays on COVID-19 deaths during 2020 and 2021 in Hong Kong: an observational study

Abstract

Bibliographical note

Funding

UN SDGs

Research Keywords

Publisher's Copyright Statement

RGC Funding Information

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Other Files and Links

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GRF: Identifying Vaccine Target Groups to Reduce COVID-19 Hospitalizations by Modelling Waning Immunity

HMRF: Modelling of Hong Kong COVID-19 Control Strategies Considering Different Population Immunity Scenarios

Cite this

Impacts of income inequality and the mediation role of reporting delays on COVID-19 deaths during 2020 and 2021 in Hong Kong: an observational study

Abstract

Bibliographical note

Funding

UN SDGs

Research Keywords

Publisher's Copyright Statement

RGC Funding Information

Access Output

Other Access Options

Permanent Link

Other Files and Links

Fingerprint

Projects

GRF: Identifying Vaccine Target Groups to Reduce COVID-19 Hospitalizations by Modelling Waning Immunity

HMRF: Modelling of Hong Kong COVID-19 Control Strategies Considering Different Population Immunity Scenarios

Cite this