The COVID-19 Pandemic Remodeled as a Syndemic Driven by Health and Social Disparities

Abstract

COVID-19 disproportionately affects racial minority groups and those with non-communicable diseases. Overlap in disease epidemics caused by social inequities sparked conversations about a COVID-19 syndemic. A syndemic occurs when the interaction between biological disease states and social environment causes a synergistic increased burden of negative health outcomes to cluster within a population, place, or time. Cumulative COVID-19 morbidity and mortality for the first three epidemic waves in Ontario were modeled as a syndemic using multilevel models. Interaction terms between proxy measures of racial marginalization and COVID-19 comorbidities were included to model the hypothesized synergistic biosocial interaction that increases the burden of COVID-19. The theorized syndemic effect varied by wave and appeared to be strongest during the second wave. Further, the syndemic effect seems to have had a larger impact on COVID-19 morbidity in comparison to mortality. These findings highlighted the importance of addressing racial marginalization to better Ontario’s population health.