RESUMO
OBJECTIVE: To assess the association between social determinants of health (SDH) and resilience in older people during the first period of confinement in the COVID-19 pandemic in Chile. MATERIALS AND METHODS: An observational study with a cross-sectional design was conducted using a nationally representative survey data-set. In this survey, using a systematic randomization process, a subsample of people aged ≥60 years from the community were interviewed by telephone during the first wave of the COVID-19 pandemic in Chile. Resilience was assessed using the Brief Resilient Coping Scale (BRCS) and depressive symptoms using the Patient Health Questionnaire (PHQ-9) scale. The SDH considered were: age, sex, educational level, employment status, social isolation, loneliness, discontent with housing and health care needs. RESULTS: A total sample of 582 persons was obtained. The mean age was 71 years (SD: 7.64; 69% women). A significant association was obtained between low resilience and the following conditions: loneliness (OR: 1.776 [95% CI: 1.146-2.751]), high risk of social isolation (OR: 1.667 [95% CI: 1.149-2.419]), and depressive symptoms (OR: 2.602 [95% CI: 1.795-3.774]). Female gender was a protective factor (OR: 0.589 [95% CI: 0.406-0.855]). CONCLUSION: The SDH, such as loneliness and social isolation, are factors associated with low resilience in older people during the COVID-19 pandemic and may be taken into account in planning public health intervention strategies.
Assuntos
COVID-19 , Feminino , Humanos , Idoso , Masculino , COVID-19/epidemiologia , Pandemias , Estudos Transversais , Determinantes Sociais da Saúde , Chile/epidemiologiaRESUMO
INTRODUCTION: Historically, pandemics have resulted in higher mortality rates in the most vulnerable populations. Social determinants of health (SDH) have been associated with people morbidity and mortality at different levels. OBJECTIVE: To determine the relationship between SDH and COVID-19 severity and mortality. METHODS: Retrospective study, where data from patients with COVID-19 were collected at a public hospital in Chile. Sociodemographic variables related to structural SDH were classified according to the following categories: gender, age (< 65 years, ≥ 65 years), secondary education (completed or not), work status (active, inactive) and income (< USD 320, ≥ USD 320). RESULTS: A total of 1,012 laboratory-confirmed COVID-19 cases were included. Average age was 64.2 ± 17.5 years. Mortality of the entire sample was 14.5 %. Age, level of education, unemployment and income had a strong association with mortality (p < 0.001). CONCLUSIONS: The findings reinforce the idea that SDH should be considered a public health priority, which is why political efforts should focus on reducing health inequalities for future generations.
INTRODUCCIÓN: Históricamente, las pandemias han tenido como resultado tasas de mortalidad más altas en las poblaciones más vulnerables. Los determinantes sociales de la salud (DSS) se han asociado a la morbimortalidad de las personas en diferentes niveles. OBJETIVO: Determinar la relación entre los DSS, la severidad de COVID-19 y la mortalidad por esta enfermedad. MÉTODOS: Estudio retrospectivo en el que se recolectaron datos de pacientes con COVID-19 en un hospital público de Chile. Las variables sociodemográficas relacionadas con los DSS estructurales se clasificaron según las siguientes categorías: sexo, edad (< 65 años, ≥ 65 años), educación secundaria (completada o no), condición de trabajo (activo, inactivo) e ingreso económico (< USD 320, ≥ USD 320). RESULTADOS: Fueron incluidos 1012 casos con COVID-19 confirmados por laboratorio. La edad promedio fue de 64.2 ± 17.5 años. La mortalidad de la muestra total fue de 14.5 %. La edad, nivel educativo, desempleo e ingresos tuvieron fuerte asociación con la mortalidad (p < 0.001). CONCLUSIONES: Los hallazgos refuerzan la idea de que los DSS deben considerarse una prioridad de salud pública, por lo que los esfuerzos políticos deben centrarse en reducir las desigualdades en salud para las generaciones futuras.
Assuntos
COVID-19/epidemiologia , Determinantes Sociais da Saúde , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , COVID-19/mortalidade , COVID-19/fisiopatologia , Chile/epidemiologia , Escolaridade , Feminino , Hospitais Públicos , Humanos , Renda/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Desemprego/estatística & dados numéricosRESUMO
Resumen Introducción: Históricamente, las pandemias han tenido como resultado tasas de mortalidad más altas en las poblaciones más vulnerables. Los determinantes sociales de la salud (DSS) se han asociado a la morbimortalidad de las personas en diferentes niveles. Objetivo: Determinar la relación entre los DSS, la severidad de COVID-19 y la mortalidad por esta enfermedad. Métodos: Estudio retrospectivo en el que se recolectaron datos de pacientes con COVID-19 en un hospital público de Chile. Las variables sociodemográficas relacionadas con los DSS estructurales se clasificaron según las siguientes categorías: sexo, edad (< 65 años, ≥ 65 años), educación secundaria (completada o no), condición de trabajo (activo, inactivo) e ingreso económico (< USD 320, ≥ USD 320). Resultados: Fueron incluidos 1012 casos con COVID-19 confirmados por laboratorio. La edad promedio fue de 64.2 ± 17.5 años. La mortalidad de la muestra total fue de 14.5 %. La edad, nivel educativo, desempleo e ingresos tuvieron fuerte asociación con la mortalidad (p < 0.001). Conclusiones: Los hallazgos refuerzan la idea de que los DSS deben considerarse una prioridad de salud pública, por lo que los esfuerzos políticos deben centrarse en reducir las desigualdades en salud para las generaciones futuras.
Abstract Introduction: Historically, pandemics have resulted in higher mortality rates in the most vulnerable populations. Social determinants of health (SDH) have been associated with people morbidity and mortality at different levels. Objective: To determine the relationship between SDH and COVID-19 severity and mortality. Methods: Retrospective study, where data from patients with COVID-19 were collected at a public hospital in Chile. Sociodemographic variables related to structural SDH were classified according to the following categories: gender, age (< 65 years, ≥ 65 years), secondary education (completed or not), work status (active, inactive) and income (< USD 320, ≥ USD 320). Results: A total of 1,012 laboratory-confirmed COVID-19 cases were included. Average age was 64.2 ± 17.5 years. Mortality of the entire sample was 14.5 %. Age, level of education, unemployment and income had a strong association with mortality (p < 0.001). Conclusions: The findings reinforce the idea that SDH should be considered a public health priority, which is why political efforts should focus on reducing health inequalities for future generations.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Determinantes Sociais da Saúde , COVID-19/epidemiologia , Desemprego/estatística & dados numéricos , Índice de Gravidade de Doença , Chile/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Fatores Etários , Escolaridade , COVID-19/fisiopatologia , COVID-19/mortalidade , Hospitais Públicos , Renda/estatística & dados numéricosRESUMO
AIM OF THE STUDY: Analyze the association between social health determinants (SHD) and chronic post-surgical pain (CPSP) after total knee arthroplasty (TKA). METHOD: A cross-sectional study was performed in 58 TKA patients. The subjects were classified in two groups: with (n = 22) or without (n = 36) CPSP. SHD considered were gender, age, educational level, economic income, and labour conditions. RESULTS: Significant differences were found concerning educational level when comparing subjects with or without CPSP, with a low educational level of 22.4% and 19%, respectively. 15.5% of patients with persistent pain had a high educational level compared with 43.1% of the patients without persistent pain (p = 0.032). No significant differences were found for the other categories (p > 0.05). The odds ratio (95% confidence interval) was 3.28 (1.09-9.93) for lower educational level compared with high educational level. DISCUSSION: CPSP must be considered a severe health problem. In addition to SDH, there are multiple factors associated with chronic pain after TKA that must be considered for an effective treatment. CONCLUSIONS: Patients with lower educational level showed a three-time higher association to develop CPSP. Considering SHD could be of relevance when elaborating new interventions or health strategies and more specialized counseling for patients with persistent pain after TKA.