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Variations in the financial impact of the COVID-19 pandemic across 5 continents: A cross-sectional, individual level analysis

Khetan AK 1 , Yusuf S 1 , Lopez-Jaramillo P 2 , Szuba A 3 , Orlandini A 4 , Mat-Nasir N 5 Show all authors , Oguz A 6 , Gupta R 7 , Avezum Á 8 , Rosnah I 9 , Poirier P 10 , Teo KK 1 , Wielgosz A 11 , Lear SA 12 , Palileo-Villanueva LM 13 , Serón P 14 , Chifamba J 15 , Rangarajan S 1 , Mushtaha M 1 , Mohan D 16 , Yeates K 17 , McKee M 18 , Mony PK 19 , Walli-Attaei M 1 , Khansaheb H 20 , Rosengren A 21 , Alhabib KF 22 , Kruger IM 23 , Paucar MJ 24 , Mirrakhimov E 25 , Assembekov B 26 , Leong DP 1

Affiliations 

  • 1 Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON L8L 2X2, Canada
  • 2 Medical School, Universidad de Santander (UDES), Masira Research Institute, Bucaramanga, Colombia
  • 3 Department of Angiology, Hypertension and Diabetology, Wroclaw Medical University, Wroclaw, Poland
  • 4 ECLA (Estudios Clínicos Latino America) Instituto Cardiovascular de Rosario, Argentina
  • 5 Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia
  • 6 Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
  • 7 Eternal Heart Care Center and Research Institute, Jaipur, India
  • 8 International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
  • 9 Faculty of Medicine of UKM, UKM Medical Center, Kuala Lumpur, Malaysia
  • 10 Faculté de pharmacie, Université Laval, Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada
  • 11 University of Ottawa Heart Institute, Ottawa, ON, Canada
  • 12 Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
  • 13 UP College of Medicine, University of the Philippines Manila, Manila, Philippines
  • 14 Faculty of Medicine, Universidad de La Frontera, Claro Solar, Temuco, Chile
  • 15 Department of Biomedical Sciences, Physiology Unit, Faculty of Medicine and Sciences, University of Zimbabwe, Zimbabwe
  • 16 Department of Epidemiology, Madras Diabetes Research Foundation, Chennai, India
  • 17 Department of Medicine, Queen's University, Kingston, ON, Canada
  • 18 London School of Hygiene and Tropical Medicine, London, United Kingdom
  • 19 St John's Medical College & Research Institute, Bangalore, India
  • 20 Dubai Health Authority, Dubai, United Arab Emirates
  • 21 Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, VGR region, Sweden
  • 22 King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
  • 23 Potchefstroom Campus, Africa Unit for Transdisciplinary Health Research (AUTHeR), North-West University, South Africa
  • 24 Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador
  • 25 Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan
  • 26 Al-Farabi Kazakh National University, Almaty, Kazakhstan
EClinicalMedicine, 2022 Feb;44:101284.
PMID: 35106472 DOI: 10.1016/j.eclinm.2022.101284

Abstract

BACKGROUND: COVID-19 has caused profound socio-economic changes worldwide. However, internationally comparative data regarding the financial impact on individuals is sparse. Therefore, we conducted a survey of the financial impact of the pandemic on individuals, using an international cohort that has been well-characterized prior to the pandemic.

METHODS: Between August 2020 and September 2021, we surveyed 24,506 community-dwelling participants from the Prospective Urban-Rural Epidemiology (PURE) study across high (HIC), upper middle (UMIC)-and lower middle (LMIC)-income countries. We collected information regarding the impact of the pandemic on their self-reported personal finances and sources of income.

FINDINGS: Overall, 32.4% of participants had suffered an adverse financial impact, defined as job loss, inability to meet financial obligations or essential needs, or using savings to meet financial obligations. 8.4% of participants had lost a job (temporarily or permanently); 14.6% of participants were unable to meet financial obligations or essential needs at the time of the survey and 16.3% were using their savings to meet financial obligations. Participants with a post-secondary education were least likely to be adversely impacted (19.6%), compared with 33.4% of those with secondary education and 33.5% of those with pre-secondary education. Similarly, those in the highest wealth tertile were least likely to be financially impacted (26.7%), compared with 32.5% in the middle tertile and 30.4% in the bottom tertile participants. Compared with HICs, financial impact was greater in UMIC [odds ratio of 2.09 (1.88-2.33)] and greatest in LMIC [odds ratio of 16.88 (14.69-19.39)]. HIC participants with the lowest educational attainment suffered less financial impact (15.1% of participants affected) than those with the highest education in UMIC (22.0% of participants affected). Similarly, participants with the lowest education in UMIC experienced less financial impact (28.3%) than those with the highest education in LMIC (45.9%). A similar gradient was seen across country income categories when compared by pre-pandemic wealth status.

INTERPRETATION: The financial impact of the pandemic differs more between HIC, UMIC, and LMIC than between socio-economic categories within a country income level. The most disadvantaged socio-economic subgroups in HIC had a lower financial impact from the pandemic than the most advantaged subgroup in UMIC, with a similar disparity seen between UMIC and LMIC. Continued high levels of infection will exacerbate financial inequity between countries and hinder progress towards the sustainable development goals, emphasising the importance of effective measures to control COVID-19 and, especially, ensuring high vaccine coverage in all countries.

FUNDING: Funding for this study was provided by the Canadian Institutes of Health Research and the International Development Research Centre.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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