higher socioeconomic status groups regardless of race and ethnicity. These results may be caused by decreased rates of screening, a lack of health insurance, or later access to care among those of lower socioeconomic status. A study examining the occupational exposures among individuals in Europe and North America with lung cancer revealed that after controlling for smoking history and job exposure, men of lower socioeconomic status had higher rates of lung cancer than both men and women of higher socioeconomic status. Unemployment with a duration of 5 to 10 years and greater than 10 years also increased the risk for lung cancer in men (Hovanec, 2018). The COVID-19 pandemic substantially affected millions through loss of jobs, thereby exacerbating health outcome disparities, including among the elderly, individuals in lower socioeconomic categories, and those in poor or rural areas in the U.S. The effects of COVID-19 were experienced by everyone as a result of government-mandated shelter in place, resulting in closure of schools, restaurants, medical practices, and government offices. Further, it ended the work of many volunteer agencies. However, because of limited resources, those dealing with social disadvantages experienced more severe effects. Low-income communities saw increased exposure because of overcrowding, the presence of chronic health conditions, and inadequate nutrition. Adhilkari and colleagues (2020) found that in 10 major U.S. cities, rates of COVID-19 were higher than in cities with a lower mean income. Researchers further examined county data, finding that regardless of income, COVID-19 morbidity rates were higher in those with higher percentages of non-White or diverse populations than in those with substantially White or a less diverse population (Adhikari et al., 2020). A study from the University of Chicago found twice as many individuals in low-income groups lost wages in the first several months of COVID-19 than those with higher incomes, and women were affected more than men. This loss in pay affects insurance benefits and the ability to pay for food, rent, childcare, and transportation needs. Low wage workers who were considered essential and who maintained their jobs during the pandemic were at increased risk of developing COVID-19 because of exposure to the general public (Bertrand et al., 2020). The COVID-19 pandemic highlighted significant issues related to housing and health. People living in overcrowded housing settings and those struggling with homelessness experienced higher risks of COVID-19 exposure due to difficulties with social distancing (Johns & Rapfogel, 2023). Risks of domestic violence with families spending increased time together because of the loss of social outlets, closure of schools, and changes in employment were increased at the height of the pandemic. Increased stress and frustration is unlikely to cause a previously nonviolent person to become violent, but it may be enough to trigger someone with a history of abusing (Substance Abuse and Mental Health Services Administration, n.d.). Closure of reliable support systems because of required restrictions influenced the health and well-being of individuals. Examples include closure of food banks; closure of volunteer food kitchens; and cancellation of support groups such as Alcoholics Anonymous, early childhood education, and mental health treatment. Delays in routine
Evidence-Based Practice! A study on non–small cell lung cancer, where surgery would be standard treatment, found that as the number of socioeconomic status factors increase (income, education, race, living environment, insurance), the odds of no therapy or nonstandard therapy rise. Those receiving low income, living in a zip code with low high school graduation rates, having no insurance (or having Medicaid), living in close proximity to treatment, and living in a rural area were less likely to undergo any treatment or to undergo nonstandard treatment. The presence of any of these factors was identified as increasing the odds that an individual would not undergo treatment. The five-year survival rate of patients receiving standard treatment was 71.8%, no treatment 21.8%, and nonstandard treatment 22.7% (Ebner et al., 2020). care have also occurred, which during the initial onset of the pandemic was unavoidable but has continued. By May 2020, routine vaccination immunization rates declined to less than 50% among children age 2 years and younger, leading to concern over delayed measles immunizations in the U.S. and worldwide (Langdon-Embry et al., 2020). Alcohol and opioid addiction are not limited to individuals affected by lower socioeconomic status or people who are racial or ethnic minorities; however, research has shown that addiction affects those living in poverty at disproportionate rates (Bohler et al., 2021). Individuals suffering with addiction were more vulnerable to COVID-19 infection as a result of an increased likelihood of homelessness, low socioeconomic status, smoking status, lack of insurance or being underinsured, and chronic disease (lung or cardiovascular disease). Treatment programs were initially affected, and there was an increase in virtual and telephone visits. Access to clean needle programs and limited admissions to rehabilitation facilities affected numerous individuals. The decrease in positive social support arising from fewer peer group meetings (which are a vital source of spiritual and emotional support to those with addiction) impacted recovery. Anxiety and environment/social stress are triggers for alcohol and drug use that can lead to relapse, overdose, or death. Basic survival needs often take priority over seeking treatment for substance abuse or mental health (Grinspoon, 2020). Food insecurity, a nationwide problem before COVID-19, has also been affected by the pandemic. Although grocery stores, considered essential businesses, continued to operate throughout the pandemic, several problems occurred. Stores experienced long lines and shortages of products because of panic buying of items such as toilet paper, cleaning supplies, soap, infant formula, and canned goods. Shortages caused difficulty for everyone, particularly individuals on a fixed income or receiving food stamps. Small neighborhood stores were unable to compete with large chains for access to the supply distributors (Center for Strategic & International Studies, 2020). The Families First Coronavirus Response Act provided flexibility with the Supplementary Nutrition Assistance Program (SNAP) for eligible households to apply for maximum benefits and waiving in-person appointments for new participants. There were also changes to many of the available SNAP programs. Recognizing the closure of available programs (school lunch, Meals on Wheels, meals with friends), they provided contact information for available substitute resources (Food Resource and Action Center, 2020).
COVID-19 AND SOCIAL DETERMINANTS OF HEALTH
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Book Code: MTX1326
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