Photo: Michael Erhardsson / Mostphotos

Karl Gauffin, researcher at the Department of Public Health Sciences at Stockholm University. Photo: Stockholm University.

During the pandemic´s first wave, income related inequalities in intensive care in Sweden were very modest. However, during the second wave they were more prominent. The third waves saw the general risk of intensive care notably decreasing, generally speaking. But still the relative income differences were significant. This is stated by Karl Gauffin, researcher at the Department of Public Health Sciences at Stockholm University. He is the first author of the article Waves of inequality: income differences in intensive care due to Covid-19 in Sweden, which was published recently in the European Journal of Public Health.

Economically weaker groups are more vulnerable

Gauffin says that these results are in line with previous theories about health gaps showing that a person's resources become more important as the understanding of a new disease increases.

“Economic assets, occupational advantages and social networks provide certain groups with better opportunities to protect themselves from infection and serious disease, while other groups remain exposed and vulnerable,” says Gauffin.

An important conclusion of the study, according to Gauffin, is that the factors connecting income and illness shifted during the course of the pandemic. He refers to a well-known observation regarding new diseases, such as Covid-19: As soon as one begins to understand more about how the disease spreads and what can be done to avoid getting sick, the social inequalities in terms of who is affected are reinforced, he states.

“Resourceful groups are able to use money, contacts, professional benefits and other health-promoting assets in order to minimize the risk of illness, sometimes at the expense of other people. Groups lacking these opportunities simply run a greater risk of being exposed to and infected by the virus. In addition, they often also run a greater risk of becoming sicker, for example due to a higher incidence of another disease,” says Gauffin.

High income earners were vaccinated to a greater extent

Why then were the income inequalities more prominent during the pandemic’s second wave, and still significant during the third wave? According to Gauffin, one possible explanation has to do with the changing contexts in which the virus spread, and also which groups were affected by it.

“At the beginning of the first wave, before Covid-19 had taken hold in Sweden, Swedish people were mainly infected on sports holiday trips to the Alps. That is to say, it was a relatively well-resourced group that was infected first,” says Gauffin.

“When the virus had taken hold in Sweden, it began to spread among the low-income earners. Possible contexts here could be the workplace with limited opportunities to work from home, overcrowding and travel by public transport.”

According to Gauffin, the fact that the relative income differences were strengthened during the third wave, despite the general need for intensive care linked to Covid-19 decreasing significantly, partly has to do with high-income earners being vaccinated to a greater extent than low-income earners.

However, it is important to emphasize that the majority of the population, both high-income earners and low-income earners, were vaccinated (94 per cent of the quarter with the highest income and 78 per cent of the quarter with the lowest income), says Gauffin.

The fact that the Covid-19 vaccine was given free of charge was a very important factor in preventing further income disparities with regards to serious illness.

“This is something that should be taken into account with regard to other vaccines that currently cost money,” says Gauffin.

He hopes that this study will contribute to the discussion around these shifting factors that change the link between resources and disease over the course of an epidemic.

“In the beginning it is often said that we are "in the same boat", but eventually it becomes clear that this is not true. Our project aims to investigate the political determinants of inequality in health. Consequently, we believe it is particularly interesting to investigate the effects political decisions and measures have on the spread of a disease, as well as their effects on public health in general,” says Gauffin.

Håkan Soold