[Social determinants and COVID-19 mortality: Systematic review of the role of primary care].

Authors

Carlos Eduardo de Sousa Praxedes, Gonçalo Alves de Sousa Santinha, Sharmênia de Araújo Soares Nuto, Roberto Wagner Junior Freire, Kelen Gomes Ribeiro, Luiz Odorico Monteiro de Andrade

Published in

Atencion primaria. Volume 58. Issue 11. Pages 103617. Sep 23, 2026. Epub Sep 23, 2026.

Abstract

To synthesize associations between social determinants and COVID-19 mortality and examine the role of primary care.
Systematic review registered in PROSPERO (CRD42024502678) and reported according to PRISMA 2020.
PubMed/MEDLINE, EMBASE, Web of Science and Scopus, in English, Portuguese, or Spanish.
Observational studies addressing social determinants, COVID-19 mortality, and primary care.
Country, design, determinants, role of primary care, outcome, and association measures.
Of 259 records, 24 studies were included; 14 were conducted in the US and 13 had an ecological design. In a Spanish cohort, income<€18,000 was associated with higher mortality (aOR 3.29; 95% CI 2.16-5.03), consistent with other studies of deprivation. Across 3141 US counties, the highest social-vulnerability quintile had higher mortality (RR 2.42; 95% CI 2.22-2.64), with a similar direction in other territorial analyses. In Georgia, primary care professional shortage was associated with higher mortality (RR 1.74; 95% CI 1.00-3.00), whereas in Texas greater primary care physician density was associated with lower odds of recording a death (OR 0.93; 95% CI 0.89-0.99). Race/ethnicity-related effects varied by context. Methodological heterogeneity, predominance of ecological designs, and concentration of US studies limit generalizability.
COVID-19 mortality was socially stratified and territorially modulated. Primary care showed associations compatible with a partial mitigating effect but does not replace redistributive and intersectoral policies.

PMID:
42777291
Bibliographic data and abstract were imported from PubMed on 24 Sep 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.