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The association between socioeconomic status and pandemic influenza: protocol for a systematic review and meta-analysis

Affiliations

• ¹ Work Research Institute at OsloMet - Oslo Metropolitan University, PO. Box 4, St. Olavs plass, 0130, Oslo, Norway. Svenn-Erik.Mamelund@oslomet.no.
• ² Work Research Institute at OsloMet - Oslo Metropolitan University, PO. Box 4, St. Olavs plass, 0130, Oslo, Norway.
• ³ Frisch Centre, Gaustadalleen 21, 0349, Oslo, Norway.

• PMID: 30609940
• PMCID: PMC6318944
• DOI: 10.1186/s13643-018-0931-2

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Svenn-Erik Mamelund et al. Syst Rev. 2019.

• ¹ Work Research Institute at OsloMet - Oslo Metropolitan University, PO. Box 4, St. Olavs plass, 0130, Oslo, Norway. Svenn-Erik.Mamelund@oslomet.no.
• ² Work Research Institute at OsloMet - Oslo Metropolitan University, PO. Box 4, St. Olavs plass, 0130, Oslo, Norway.
• ³ Frisch Centre, Gaustadalleen 21, 0349, Oslo, Norway.

• PMID: 30609940
• PMCID: PMC6318944
• DOI: 10.1186/s13643-018-0931-2

Item in Clipboard

Background: Pandemic mortality rates in 1918 and in 2009 were highest among those with the lowest socioeconomic status (SES). Despite this, low SES groups are not included in the list of groups prioritized for pandemic vaccination, and the ambition to reduce social inequality in health does not feature in international and national pandemic preparedness plans. We describe plans for a systematic review and meta-analysis of the association between SES and pandemic outcomes during the last five pandemics.

Method: The planned review will cover studies of pandemic influenza that report associations between morbidity, hospitalization, or mortality with socioeconomic factors such as education and income. The review will include published studies in the English, Danish, Norwegian, and Swedish languages, regardless of geographical location. Relevant records were identified through systematic literature searches in MEDLINE, Embase, Cinahl, SocIndex, Scopus, and Web of Science. Reference lists of relevant known studies will be screened and experts in the field consulted in order to identify other additional sources. Two investigators will independently screen and select studies, and discrepancies will be resolved through discussion until consensus is reached. Covidence will be used. Results will be summarized narratively and using three meta-analytic strategies: coefficients expressing the difference between the highest and lowest socioeconomic groups reported will be pooled using (a) fixed and random effects meta-analysis where studies involve similar outcome and exposure measures and (b) meta-regression where studies involve similar outcome measures. In addition, we will attempt to use all reported estimates for SES differences in (c) a Bayesian meta-analysis to estimate the underlying SES gradient and how it differs by outcome and exposure measure.

Discussion: This study will provide the first systematic review of research on the relation between SES and pandemic outcomes. The findings will be relevant for health policy in helping to assess whether people of low socioeconomic status should be prioritized for vaccines in preparedness plans for pandemic influenza. The review will also contribute to the research literature by providing pooled estimates of effect sizes as inputs into power calculations of future studies.

Systematic review registration: PROSPERO 87922.

Keywords: Education; Hospitalization; Housing conditions; Income; Morbidity; Mortality; Occupational social class; Pandemic influenza; Poverty; Socioeconomic status.

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SEM is a historical demographer, PhD, and a research professor. For 23 years, SEM has studied the demography of epidemic diseases with a focus on the 1918 influenza pandemic. The topic is timely with the centenary falling in 2018. CSE is a senior researcher with a PhD in Science and Technology Studies, and a research focus on the ethics and governance of new and emerging technologies. More recently, she has collaborated in research on public health and research policy responses to the Zika virus outbreak. OR has a PhD in Economics, and has published extensively in the field of Experimental Economics including a meta-analysis in a review of the epidemiological literature on the increased crash risks associated with cannabis.

Not applicable.

Not applicable.

The authors declare that they have no competing interests.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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