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Original article

Vol. 154 No. 5 (2024)

The association of vaccination status with perceived discrimination in patients with COVID-19: results from a cross-sectional study

  • Christoph Becker
  • Katharina Beck
  • Céline Moser
  • Clara Lessing
  • Armon Arpagaus
  • Sebastian Gross
  • Tabita Urben
  • Rainer Schaefert
  • Simon Amacher
  • Stefano Bassetti
  • Philipp Schuetz
  • Sabina Hunziker
DOI
https://doi.org/10.57187/s.3634
Cite this as:
Swiss Med Wkly. 2024;154:3634
Published
10.05.2024

Summary

STUDY AIMS: During the COVID-19 pandemic, there was increasing pressure to be vaccinated to prevent further spread of the virus and improve outcomes. At the same time, part of the population expressed reluctance to vaccination, for various reasons. Only a few studies have compared the perceptions of vaccinated and non-vaccinated patients being treated in hospitals for COVID-19. Our aim was to investigate the association between vaccination status and perceived healthcare-associated discrimination in patients with COVID-19 receiving hospital treatment.

METHODS: Adult patients presenting to the emergency department or hospitalised for inpatient care due to or with COVID-19 from 1 June to 31 December 2021 in two Swiss hospitals were eligible. The primary endpoint was patients’ perceived healthcare-associated discrimination, measured with the Discrimination in Medical Settings (DMS) scale. Secondary endpoints included different aspects of perceived quality of care and symptoms of psychological distress measured with the Hospital Anxiety and Depression Scale.

RESULTS: Non-vaccinated patients (n = 113) had significantly higher DMS scores compared to vaccinated patients (n = 80) (mean: 9.54 points [SD: 4.84] vs 7.79 points [SD: 1.85]; adjusted difference: 1.18 [95% CI: 0.04–2.33 points]) and 21 of 80 vaccinated patients felt discriminated against vs 54 of 113 non-vaccinated patients (adjusted OR: 2.09 [95% CI: 1.10–3.99 ]). Non-vaccinated patients reported lower scores regarding respectful treatment by the nursing team (mean: 8.39 points [SD: 2.39] vs 9.30 points [SD: 1.09]; adjusted difference: –0.6 [95% CI: -1.18 – –0.02 points]).

CONCLUSION: We found an association between vaccination status and perceived healthcare-associated discrimination. Healthcare workers should act in a professional manner regardless of a patient’s vaccination status; in doing so, they might prevent the creation of negative perceptions in patients.

References

  1. Linzer M, Jin JO, Shah P, Stillman M, Brown R, Poplau S, et al. Trends in Clinician Burnout With Associated Mitigating and Aggravating Factors During the COVID-19 Pandemic. JAMA Health Forum. 2022 Nov;3(11):e224163. 10.1001/jamahealthforum.2022.4163 DOI: https://doi.org/10.1001/jamahealthforum.2022.4163
  2. Sexton JB, Adair KC, Proulx J, Profit J, Cui X, Bae J, et al. Emotional Exhaustion Among US Health Care Workers Before and During the COVID-19 Pandemic, 2019-2021. JAMA Netw Open. 2022 Sep;5(9):e2232748. 10.1001/jamanetworkopen.2022.32748 DOI: https://doi.org/10.1001/jamanetworkopen.2022.32748
  3. Aw J, Seng JJ, Seah SS, Low LL. COVID-19 Vaccine Hesitancy-A Scoping Review of Literature in High-Income Countries. Vaccines (Basel). 2021 Aug;9(8):900. 10.3390/vaccines9080900 DOI: https://doi.org/10.3390/vaccines9080900
  4. Health FOoP. Geographical distribution - Vaccinated people by canton of residence, Switzerland; Status: 03.07.2023 2023 [Available from: https://www.covid19.admin.ch/en/vaccination/persons/d/geography?geo=CH
  5. Bor A, Jørgensen F, Petersen MB. Discriminatory attitudes against unvaccinated people during the pandemic. Nature. 2023 Jan;613(7945):704–11. 10.1038/s41586-022-05607-y DOI: https://doi.org/10.1038/s41586-022-05607-y
  6. Bor A, Jørgensen F, Lindholt MF, Petersen MB. Moralizing the COVID-19 Pandemic: Self-Interest Predicts Moral Condemnation of Other’s Compliance, Distancing, and Vaccination. Polit Psychol. 2022 May. DOI: https://doi.org/10.1111/pops.12835
  7. Rosenfeld DL, Tomiyama AJ. Jab my arm, not my morality: perceived moral reproach as a barrier to COVID-19 vaccine uptake. Soc Sci Med. 2022 Feb;294:114699. 10.1016/j.socscimed.2022.114699 DOI: https://doi.org/10.1016/j.socscimed.2022.114699
  8. Bardosh K, de Figueiredo A, Gur-Arie R, Jamrozik E, Doidge J, Lemmens T, et al. The unintended consequences of COVID-19 vaccine policy: why mandates, passports and restrictions may cause more harm than good. BMJ Glob Health. 2022 May;7(5):e008684. 10.1136/bmjgh-2022-008684 DOI: https://doi.org/10.1136/bmjgh-2022-008684
  9. Schmitt MT, Branscombe NR, Postmes T, Garcia A. The consequences of perceived discrimination for psychological well-being: a meta-analytic review. Psychol Bull. 2014 Jul;140(4):921–48. 10.1037/a0035754 DOI: https://doi.org/10.1037/a0035754
  10. Baldassarre A, Giorgi G, Alessio F, Lulli LG, Arcangeli G, Mucci N. Stigma and Discrimination (SAD) at the Time of the SARS-CoV-2 Pandemic. Int J Environ Res Public Health. 2020 Aug;17(17):6341. 10.3390/ijerph17176341 DOI: https://doi.org/10.3390/ijerph17176341
  11. Rewerska-Juśko M, Rejdak K. Social Stigma of Patients Suffering from COVID-19: Challenges for Health Care System. Healthcare (Basel). 2022 Feb;10(2):292. 10.3390/healthcare10020292 DOI: https://doi.org/10.3390/healthcare10020292
  12. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007 Oct;370(9596):1453–7. 10.1016/S0140-6736(07)61602-X DOI: https://doi.org/10.1016/S0140-6736(07)61602-X
  13. Smith GB, Prytherch DR, Meredith P, Schmidt PE, Featherstone PI. The ability of the National Early Warning Score (NEWS) to discriminate patients at risk of early cardiac arrest, unanticipated intensive care unit admission, and death. Resuscitation. 2013 Apr;84(4):465–70. 10.1016/j.resuscitation.2012.12.016 DOI: https://doi.org/10.1016/j.resuscitation.2012.12.016
  14. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83. 10.1016/0021-9681(87)90171-8 DOI: https://doi.org/10.1016/0021-9681(87)90171-8
  15. Peek ME, Nunez-Smith M, Drum M, Lewis TT. Adapting the everyday discrimination scale to medical settings: reliability and validity testing in a sample of African American patients. Ethn Dis. 2011;21(4):502–9.
  16. Williams DR, Yan Yu, Jackson JS, Anderson NB. Racial Differences in Physical and Mental Health: Socio-economic Status, Stress and Discrimination. J Health Psychol. 1997 Jul;2(3):335–51. 10.1177/135910539700200305 DOI: https://doi.org/10.1177/135910539700200305
  17. Benjamins MR, Middleton M. Perceived discrimination in medical settings and perceived quality of care: A population-based study in Chicago. PLoS One. 2019 Apr;14(4):e0215976. 10.1371/journal.pone.0215976 DOI: https://doi.org/10.1371/journal.pone.0215976
  18. Bird ST, Bogart LM. Perceived race-based and socioeconomic status(SES)-based discrimination in interactions with health care providers. Ethn Dis. 2001;11(3):554–63.
  19. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983 Jun;67(6):361–70. 10.1111/j.1600-0447.1983.tb09716.x DOI: https://doi.org/10.1111/j.1600-0447.1983.tb09716.x
  20. Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res. 2002 Feb;52(2):69–77. 10.1016/S0022-3999(01)00296-3 DOI: https://doi.org/10.1016/S0022-3999(01)00296-3
  21. EuroQol Group. EuroQol—a new facility for the measurement of health-related quality of life. Health Policy. 1990 Dec;16(3):199–208. 10.1016/0168-8510(90)90421-9 DOI: https://doi.org/10.1016/0168-8510(90)90421-9
  22. Dolan P. Modeling valuations for EuroQol health states. Med Care. 1997 Nov;35(11):1095–108. 10.1097/00005650-199711000-00002 DOI: https://doi.org/10.1097/00005650-199711000-00002
  23. Sterne JA, White IR, Carlin JB, Spratt M, Royston P, Kenward MG, et al. Multiple imputation for missing data in epidemiological and clinical research: potential and pitfalls. BMJ. 2009 Jun;338 jun29 1:b2393. 10.1136/bmj.b2393 DOI: https://doi.org/10.1136/bmj.b2393
  24. Chew CC, Lim XJ, Chang CT, Rajan P, Nasir N, Low WY. Experiences of social stigma among patients tested positive for COVID-19 and their family members: a qualitative study. BMC Public Health. 2021 Sep;21(1):1623. 10.1186/s12889-021-11679-8 DOI: https://doi.org/10.1186/s12889-021-11679-8
  25. Claudy MC, Vijayakumar S, Campbell N. Reckless spreader or blameless victim? How vaccination status affects responses to COVID-19 patients. Soc Sci Med. 2022 Jul;305:115089. 10.1016/j.socscimed.2022.115089 DOI: https://doi.org/10.1016/j.socscimed.2022.115089
  26. Koontalay A, Suksatan W, Prabsangob K, Sadang JM. Healthcare Workers’ Burdens During the COVID-19 Pandemic: A Qualitative Systematic Review. J Multidiscip Healthc. 2021 Oct;14:3015–25. 10.2147/JMDH.S330041 DOI: https://doi.org/10.2147/JMDH.S330041
  27. Mutambudzi M, Niedwiedz C, Macdonald EB, Leyland A, Mair F, Anderson J, et al. Occupation and risk of severe COVID-19: prospective cohort study of 120 075 UK Biobank participants. Occup Environ Med. 2020 Dec;78(5):307–14. 10.1136/oemed-2020-106731 DOI: https://doi.org/10.1136/oemed-2020-106731
  28. Rahmani K, Shavaleh R, Forouhi M, Disfani HF, Kamandi M, Oskooi RK, et al. The effectiveness of COVID-19 vaccines in reducing the incidence, hospitalization, and mortality from COVID-19: A systematic review and meta-analysis. Front Public Health. 2022 Aug;10:873596. 10.3389/fpubh.2022.873596 DOI: https://doi.org/10.3389/fpubh.2022.873596
  29. Druml C, Czech H. A pandemic is no private matter: the COVID-19 vaccine mandate in Austria. Lancet Respir Med. 2022 Apr;10(4):322–4. 10.1016/S2213-2600(22)00063-7 DOI: https://doi.org/10.1016/S2213-2600(22)00063-7
  30. King J, Ferraz OL, Jones A. Mandatory COVID-19 vaccination and human rights. Lancet. 2022 Jan;399(10321):220–2. 10.1016/S0140-6736(21)02873-7 DOI: https://doi.org/10.1016/S0140-6736(21)02873-7
  31. Shaw D. Vaccination status and intensive care unit triage: is it fair to give unvaccinated Covid-19 patients equal priority? Bioethics. 2022 Oct;36(8):883–90. 10.1111/bioe.13069 DOI: https://doi.org/10.1111/bioe.13069
  32. UNDP. 2020 Gender Social Norms Index (GSNI). UNDP. United Nations Development Programme; 2020.
  33. Todorov A, Kaufmann F, Arslani K, Haider A, Bengs S, Goliasch G, et al.; Swiss Society of Intensive Care Medicine. Gender differences in the provision of intensive care: a Bayesian approach. Intensive Care Med. 2021 May;47(5):577–87. 10.1007/s00134-021-06393-3 DOI: https://doi.org/10.1007/s00134-021-06393-3
  34. Samulowitz A, Gremyr I, Eriksson E, Hensing G. “Brave Men” and “Emotional Women”: A Theory-Guided Literature Review on Gender Bias in Health Care and Gendered Norms towards Patients with Chronic Pain. Pain Res Manag. 2018 Feb;2018:6358624. 10.1155/2018/6358624 DOI: https://doi.org/10.1155/2018/6358624
  35. Reichmuth ML, Heron L, Riou J, Moser A, Hauser A, Low N, et al. Socio-demographic characteristics associated with COVID-19 vaccination uptake in Switzerland: longitudinal analysis of the CoMix study. BMC Public Health. 2023 Aug;23(1):1523. 10.1186/s12889-023-16405-0 DOI: https://doi.org/10.1186/s12889-023-16405-0
  36. Batbaatar E, Dorjdagva J, Luvsannyam A, Savino MM, Amenta P. Determinants of patient satisfaction: a systematic review. Perspect Public Health. 2017 Mar;137(2):89–101. 10.1177/1757913916634136 DOI: https://doi.org/10.1177/1757913916634136
  37. Spaccatini F, Giovannelli I, Pacilli MG. “You are stealing our present”: younger people’s ageism towards older people predicts attitude towards age-based COVID-19 restriction measures. J Soc Issues. 2022 Aug;78(4):769–89. 10.1111/josi.12537 DOI: https://doi.org/10.1111/josi.12537
  38. Chutiyami M, Cheong AM, Salihu D, Bello UM, Ndwiga D, Maharaj R, et al. COVID-19 Pandemic and Overall Mental Health of Healthcare Professionals Globally: A Meta-Review of Systematic Reviews. Front Psychiatry. 2022 Jan;12:804525. 10.3389/fpsyt.2021.804525 DOI: https://doi.org/10.3389/fpsyt.2021.804525
  39. Delgado N, Bonache H, Betancort M, Morera Y, Harris LT. Understanding the Links between Inferring Mental States, Empathy, and Burnout in Medical Contexts. Healthcare (Basel). 2021 Feb;9(2):158. 10.3390/healthcare9020158 DOI: https://doi.org/10.3390/healthcare9020158
  40. Lluch C, Galiana L, Doménech P, Sansó N. The Impact of the COVID-19 Pandemic on Burnout, Compassion Fatigue, and Compassion Satisfaction in Healthcare Personnel: A Systematic Review of the Literature Published during the First Year of the Pandemic. Healthcare (Basel). 2022 Feb;10(2):364. 10.3390/healthcare10020364 DOI: https://doi.org/10.3390/healthcare10020364
  41. Fox J, Meisenberg B. The 3-Fold Harms of Compassion Fatigue During COVID-19 Surges. Am J Med. 2022 Aug;135(8):e234–5. 10.1016/j.amjmed.2022.01.023 DOI: https://doi.org/10.1016/j.amjmed.2022.01.023
  42. Trivedi AN, Ayanian JZ. Perceived discrimination and use of preventive health services. J Gen Intern Med. 2006 Jun;21(6):553–8. 10.1111/j.1525-1497.2006.00413.x DOI: https://doi.org/10.1111/j.1525-1497.2006.00413.x
  43. Bazargan M, Cobb S, Assari S. Discrimination and Medical Mistrust in a Racially and Ethnically Diverse Sample of California Adults. Ann Fam Med. 2021;19(1):4–15. 10.1370/afm.2632 DOI: https://doi.org/10.1370/afm.2632
  44. Razai MS, Osama T, McKechnie DG, Majeed A. Covid-19 vaccine hesitancy among ethnic minority groups. BMJ. 2021 Feb;372(513):n513. 10.1136/bmj.n513 DOI: https://doi.org/10.1136/bmj.n513
  45. Robinson E, Jones A, Lesser I, Daly M. International estimates of intended uptake and refusal of COVID-19 vaccines: A rapid systematic review and meta-analysis of large nationally representative samples. Vaccine. 2021 Apr;39(15):2024–34. 10.1016/j.vaccine.2021.02.005 DOI: https://doi.org/10.1016/j.vaccine.2021.02.005
  46. Becker C, Beck K, Zumbrunn S, Memma V, Herzog N, Bissmann B, et al. Long COVID 1 year after hospitalisation for COVID-19: a prospective bicentric cohort study. Swiss Med Wkly. 2021 Oct;151(4142):w30091. 10.4414/SMW.2021.w30091 DOI: https://doi.org/10.4414/SMW.2021.w30091

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