Assessing the association between elements of health inequalities and the risk of bacterial infection in high-income countries: a systematic scoping review

Introduction There is sufficient evidence to support the notion that the rate of infection is higher in vulnerable groups than in the wider population. This scoping review sought to further elucidate the relationship between health inequalities and the risk of bacterial infections in high-income countries. Methods Factors associated with health inequalities were defined as socioeconomic status and deprivation (employment status, income levels, deprivation categories); protected characteristics (age, gender, ethnicity, sexual orientation, disability); inclusion health groups (migration status, sex workers, people who inject drugs, the homeless) and geography (urban or rural dwelling). The published literature search was conducted on Embase, Google and Medline with a grey literature search also conducted. Exclusion criteria were defined as papers that were either published pre-2010, set in low- or middle-income countries, or that covered viral, parasitic, or fungal pathogens. Key pathogens and infections to include were determined by review of the UK antimicrobial resistance (AMR) National Action Plan. Results The search yielded 343 papers; of which, 70 were eligible for review. The most frequently reported infections were sexually transmitted infections (STIs), infectious diseases e.g. Mycobacterium tuberculosis and sexually transmitted blood-borne infections. Most papers reviewed cited multiple health inequalities, most notably ethnicity (21/70), race (18/70), age (14/70), sex (13/70) and socio-economic status and deprivation and inclusion health groups (sex workers and people experiencing drug and alcohol dependence). Conclusion Evidence has emerged highlighting an important association between factors commonly associated with health inequalities and the increased risk of bacterial infections within high-income countries. Notably, ethnic populations, members of the LGBTQ+ community, people experiencing homelessness and those of a poor socioeconomic status are at a higher risk of bacterial infection.