The role of socio-economic determinants in SARS-CoV-2 health outcomes: systematic review of population-based studies.

Introduction: The COVID-19 pandemic has accentuated a health-wealth gradient, reminiscent of patterns observed in previous influenza pandemics. This systematic review, employing a population-based approach, aims to delve into the etiological and prognostic roles of socio-economic factors on COVID-19 outcomes during the pandemic's initial phase. Methods: Our search spanned PubMed, Embase, WHO COVID-19 Global literature, and PsycINFO databases from January 2020 to April 7, 2021, focusing on English peer-reviewed articles. We examined the impact of socio-economic determinants on SARS-CoV-2 infection, COVID-19 related hospitalization, ICU admission, mechanical ventilation, mortality, and a range of prognostic outcomes including quality of life and mental health. Results: The initial search resulted in 9,701 records after removal of duplicates. Out of hundred articles that met our review criteria, 67 discussed the etiological role of socio-economic factors, 25 addressed the prognostic role, and 8 covered both. Fifty-nine percent of the studies were from the United States of America and the United Kingdom, highlighting an increased risk of infection and severity among their Black, Asian, and Hispanic populations. Lower-income groups, crowded households, and, higher socio-economic deprivation were associated with higher COVID-19 incidence and severity. Results regarding educational status varied across different waves. Conclusion: Populations groups with disadvantaged socio-economic positions and certain ethnic and racial backgrounds face a higher risk of SARS-CoV-2 infection and poorer COVID-19 outcomes. Our findings underscore the need for incorporating social determinants into routine health surveillance and monitoring, suggesting an avenue for targeted interventions.