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Sociodemographic differences in the response to changes in COVID-19 testing guidelines

Sharma, Shambhavi ; Li, Huiqi ; Löve, Jesper ; Nwaru, Chioma ; Gisslén, Magnus ; Byfors, Sara ; Hammar, Niklas ; Nilsson, Anton LU ; Björk, Jonas LU orcid and Nyberg, Fredrik , et al. (2024) In European Journal of Public Health 34(6). p.1066-1072
Abstract

During the coronavirus disease 2019 (COVID-19) pandemic, Sweden emphasized voluntary guidelines over mandates. We exploited a rapid change and reversal of the Public Health Agency of Sweden's COVID-19 testing guidelines for vaccinated and recently infected individuals as a quasi-experiment to examine sociodemographic differences in the response to changes in pandemic guidelines. We analyzed daily polymerase chain reaction tests from 1 October 2021 to 15 December 2021, for vaccinated or recently infected adults (≥20 years; n = 1 596 321) from three Swedish regions (Stockholm, Örebro, and Dalarna). Using interrupted time series analysis, we estimated abrupt changes in testing rates at the two dates when the guidelines were changed (1... (More)

During the coronavirus disease 2019 (COVID-19) pandemic, Sweden emphasized voluntary guidelines over mandates. We exploited a rapid change and reversal of the Public Health Agency of Sweden's COVID-19 testing guidelines for vaccinated and recently infected individuals as a quasi-experiment to examine sociodemographic differences in the response to changes in pandemic guidelines. We analyzed daily polymerase chain reaction tests from 1 October 2021 to 15 December 2021, for vaccinated or recently infected adults (≥20 years; n = 1 596 321) from three Swedish regions (Stockholm, Örebro, and Dalarna). Using interrupted time series analysis, we estimated abrupt changes in testing rates at the two dates when the guidelines were changed (1 November and 22 November). Stratified analysis and meta-regression were employed to explore sociodemographic differences in the strength of the response to the guideline changes. Testing rates declined substantially when guideline against testing of vaccinated and recently infected individuals came into effect on 1 November [testing rate ratio: 0.50 (95% confidence interval, CI 0.41, 0.61)], and increased again from these lowered levels by a similar amount upon its reversal on 22 November [testing rate ratio: 2.19 (95% CI: 1.69, 2.85)]. Being Sweden-born, having higher household income, or higher education, were all associated with a stronger adherent response to the guideline changes. Adjusting for stratum-specific baseline testing rates and test-positivity did not influence the results. Our findings suggest that the population was responsive to the rapid changes in testing guidelines, but with clear sociodemographic differences in the strength of the response.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
European Journal of Public Health
volume
34
issue
6
pages
7 pages
publisher
Oxford University Press
external identifiers
  • pmid:39387529
  • scopus:85212245697
ISSN
1101-1262
DOI
10.1093/eurpub/ckae145
project
Improved preparedness for future pandemics and other health crises through large-scale disease surveillance
language
English
LU publication?
yes
id
16254335-7fdb-41e5-881f-00c8534214ea
date added to LUP
2025-01-17 14:17:21
date last changed
2025-07-05 04:40:44
@article{16254335-7fdb-41e5-881f-00c8534214ea,
  abstract     = {{<p>During the coronavirus disease 2019 (COVID-19) pandemic, Sweden emphasized voluntary guidelines over mandates. We exploited a rapid change and reversal of the Public Health Agency of Sweden's COVID-19 testing guidelines for vaccinated and recently infected individuals as a quasi-experiment to examine sociodemographic differences in the response to changes in pandemic guidelines. We analyzed daily polymerase chain reaction tests from 1 October 2021 to 15 December 2021, for vaccinated or recently infected adults (≥20 years; n = 1 596 321) from three Swedish regions (Stockholm, Örebro, and Dalarna). Using interrupted time series analysis, we estimated abrupt changes in testing rates at the two dates when the guidelines were changed (1 November and 22 November). Stratified analysis and meta-regression were employed to explore sociodemographic differences in the strength of the response to the guideline changes. Testing rates declined substantially when guideline against testing of vaccinated and recently infected individuals came into effect on 1 November [testing rate ratio: 0.50 (95% confidence interval, CI 0.41, 0.61)], and increased again from these lowered levels by a similar amount upon its reversal on 22 November [testing rate ratio: 2.19 (95% CI: 1.69, 2.85)]. Being Sweden-born, having higher household income, or higher education, were all associated with a stronger adherent response to the guideline changes. Adjusting for stratum-specific baseline testing rates and test-positivity did not influence the results. Our findings suggest that the population was responsive to the rapid changes in testing guidelines, but with clear sociodemographic differences in the strength of the response.</p>}},
  author       = {{Sharma, Shambhavi and Li, Huiqi and Löve, Jesper and Nwaru, Chioma and Gisslén, Magnus and Byfors, Sara and Hammar, Niklas and Nilsson, Anton and Björk, Jonas and Nyberg, Fredrik and Bonander, Carl}},
  issn         = {{1101-1262}},
  language     = {{eng}},
  number       = {{6}},
  pages        = {{1066--1072}},
  publisher    = {{Oxford University Press}},
  series       = {{European Journal of Public Health}},
  title        = {{Sociodemographic differences in the response to changes in COVID-19 testing guidelines}},
  url          = {{http://dx.doi.org/10.1093/eurpub/ckae145}},
  doi          = {{10.1093/eurpub/ckae145}},
  volume       = {{34}},
  year         = {{2024}},
}