Determinantes sociales en el contagio de COVID-19 en la Región de Murcia
- Soriano López, Jesús
- María Dolores Chirlaque López Director
- Diego Salmerón Martínez Director
Defence university: Universidad de Murcia
Fecha de defensa: 31 October 2024
- Domingo Pérez Flores Chair
- Carmen Navarro Sánchez Secretary
- María José Sierra Moros Committee member
Type: Thesis
Abstract
Since the onset of the pandemic, the spread of SARS-CoV-2 has been closely associated with social determinants. Understanding the specific circumstances under which COVID-19 cases occur, including households, workplaces, healthcare facilities, social care settings, and leisure environments, is crucial for shaping effective public health strategies. It is essential to explore these contexts while taking into account the social and gender dynamics involved. Particularly, households have emerged as the primary locus of transmission, often measured through the secondary attack rate. Nevertheless, there are inconsistencies in the literature concerning this metric, and there is limited knowledge about its social determinants. Hence, this study aims to investigate the transmission contexts of confirmed COVID-19 cases and analyze the dynamics of household transmission, considering variables such as occupational social class, country of origin, and gender/sex. Methods: This study conducts a descriptive analysis utilizing a population based registry of newly reported COVID-19 cases. It investigates the exposure and transmission patterns, focusing on variables such as country of origin, occupational social class, and gender, within the Region of Murcia from June 15 to December 23, 2020. Furthermore, it examines the epidemiological connections between these cases and documented outbreaks. To shed light on household transmission dynamics, a retrospective cohort study was conducted among individuals living with diagnosed cases during the study period. The household secondary attack rate was assessed using a multilevel logistic regression model, considering various characteristics of both the index case and the contact. Results: The cumulative incidence was higher in individuals from Africa (5,133.5 cases per-100,000 inhabitants) and Latin America (11,351.1) compared to non-immigrants (3,145.7). It was also higher in women (3,885.6) than in men (3,572.6). The home was the primary setting for transmission (56.5% of cases with known setting), followed by social-recreational settings (20.7%) and work settings (18.2%). The latter was more significant in individuals from Africa (28.4%) and Latin America (35.7%) than in non-immigrants (12.0%), in contrast to social-recreational settings, which were more important for non-migrants. The work setting was more significant for women (19.6%) than for men (16.5%) and for manual workers (44.1%) compared to non-manual workers (26.6%). Family/multiple households (14.1%) or social (9.3%) outbreaks were linked to 23.4% of the cases. Cases associated with outbreaks in the horticultural/seasonal sector constituted 13.6% of the total, with a higher relative weight in confirmed cases from Africa (22.0%) and Latin America (37.4%) compared to non-migrants (6.3%). Among these outbreaks, 53.8% of cases were infected in a context other than work. Notably, 53.3% of registered employees were operatives in industry or construction, artisans, agricultural workers, or in elementary occupations, while 41.3% of the working population in the Murcia Region held such jobs. Regarding household transmission, among the 37,727 cohabiting contacts included, the household secondary attack rate within families was 39.1%. Contacts of confirmed primary cases from migrant populations (Africa and Latin America) had higher attack rates, even after adjusting for other variables. Age and female gender were independent risk factors for contracting SARS-CoV-2 within the home. Conclusions: This study highlights how social determinants significantly impact the dynamics of COVID-19 transmission, revealing disparities linked to factors such as country of origin, gender, and occupational social class. These findings underscore the urgency for tailored public health interventions, particularly in immigrant households that are particularly vulnerable. Moreover, the increased risk of household transmission among females underscores the necessity for gender-sensitive strategies to effectively curb the spread of COVID-19 within family settings.