Virtual CROI 2021: From COVID-19 testing to death, toll of the inverse care law continues, Swiss study finds

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Fifty years almost to the day after British physician Julian Tudor Hart described “The Inverse Care Law” in a Lancet article, a coronavirus unheard of until little more than a year ago is demonstrating the concept in action, a study in Switzerland presented at CROI today shows.

The Inverse Care Law, Dr. Hart wrote then, is in effect when “The availability of good medical care tends to vary inversely with the need for it in the population served.”

In Switzerland, where, with a population of 8.5 million, more people per million have been confirmed with the virus than in neighboring countries, but fewer have died from it (although that number is rising) researchers examined the relationship of COVID-19 testing and outcomes to socio-economic status.

To do so, they gathered data from health surveillance records with information on patients’ addresses including on education and occupation of household heads, costs, and crowding.

More affluent people got tested for COVID-19, they found, but had fewer positive tests. They also had fewer hospitalizations, fewer admissions to intensive care units, and fewer deaths due to the virus.

Initially, getting tested for COVID-19 cost money, Dr. Julian Riou, who presented the study noted. In addition, people with ongoing access to health care were likelier to have a relationship with a general practitioner who could suggest and offer information on accessing testing for COVID-19. People with ongoing access to healthcare also are less likely to have conditions, including cardiovascular disease and obesity, that contribute to more severe COVID-19 illness.

The authors call the findings “a manifestation of the inverse care law where availability of care varies inversely with the need for it.”

The presentation today is one of a series at the conference highlighting stark disparities in outcomes from the illness, demonstrated in the United States along racial and ethnic lines, with Black, Latinx and Indigenous Americans bearing the brunt of COVID-19 here.

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