Pandemic inequity in a megacity: a multilevel analysis of individual, community and healthcare vulnerability risks for COVID-19 mortality in Jakarta, Indonesia.

Autor:	Surendra H; Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia henrysurendra.15@gmail.com.; Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Yogyakarta, Indonesia., Salama N; DKI Jakarta Health Office, Jakarta, Indonesia., Lestari KD; Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia., Adrian V; DKI Jakarta Health Office, Jakarta, Indonesia., Widyastuti W; DKI Jakarta Health Office, Jakarta, Indonesia., Oktavia D; DKI Jakarta Health Office, Jakarta, Indonesia., Lina RN; Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia., Djaafara BA; Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia.; Department of Infectious Disease Epidemiology, Imperial College London, London, UK., Fadilah I; Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia., Sagara R; Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia., Ekawati LL; Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia.; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK., Nurhasim A; The Conversation Indonesia, Jakarta, Indonesia., Ahmad RA; Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Yogyakarta, Indonesia., Kekalih A; Faculty of Medicine, University of Indonesia, Jakarta, Indonesia., Syam AF; Faculty of Medicine, University of Indonesia, Jakarta, Indonesia., Shankar AH; Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia.; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK., Thwaites G; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.; Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam., Baird JK; Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia.; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK., Hamers RL; Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia.; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK., Elyazar IRF; Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia.
Jazyk:	angličtina
Zdroj:	BMJ global health [BMJ Glob Health] 2022 Jun; Vol. 7 (6).
DOI:	10.1136/bmjgh-2021-008329
Abstrakt:	Introduction: Worldwide, the 33 recognised megacities comprise approximately 7% of the global population, yet account for 20% COVID-19 deaths. The specific inequities and other factors within megacities that affect vulnerability to COVID-19 mortality remain poorly defined. We assessed individual, community-level and healthcare factors associated with COVID-19-related mortality in a megacity of Jakarta, Indonesia, during two epidemic waves spanning 2 March 2020 to 31 August 2021. Methods: This retrospective cohort included residents of Jakarta, Indonesia, with PCR-confirmed COVID-19. We extracted demographic, clinical, outcome (recovered or died), vaccine coverage data and disease prevalence from Jakarta Health Office surveillance records, and collected subdistrict level sociodemographics data from various official sources. We used multilevel logistic regression to examine individual, community and subdistrict-level healthcare factors and their associations with COVID-19 mortality. Results: Of 705 503 cases with a definitive outcome by 31 August 2021, 694 706 (98.5%) recovered and 10 797 (1.5%) died. The median age was 36 years (IQR 24-50), 13.2% (93 459) were <18 years and 51.6% were female. The subdistrict level accounted for 1.5% of variance in mortality (p<0.0001). Mortality ranged from 0.9 to 1.8% by subdistrict. Individual-level factors associated with death were older age, male sex, comorbidities and age <5 years during the first wave (adjusted OR (aOR)) 1.56, 95% CI 1.04 to 2.35; reference: age 20-29 years). Community-level factors associated with death were poverty (aOR for the poorer quarter 1.35, 95% CI 1.17 to 1.55; reference: wealthiest quarter) and high population density (aOR for the highest density 1.34, 95% CI 1.14 to 2.58; reference: the lowest). Healthcare factor associated with death was low vaccine coverage (aOR for the lowest coverage 1.25, 95% CI 1.13 to 1.38; reference: the highest). Conclusion: In addition to individual risk factors, living in areas with high poverty and density, and low healthcare performance further increase the vulnerability of communities to COVID-19-associated death in urban low-resource settings. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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