Browsing by Author "Dahal, Sushma"
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Publication Comparative analysis of COVID-19 diagnoses and mortality among hospitalized indigenous and non-indigenous populations in Chile: 2020-2021(2024) Dahal, Sushma; Delgado, Iris; Sattenspiel, Lisa; Mamelund, Svenn; Chowell, GerardoBackground: Current literature presents mixed effects of the COVID-19 pandemic on Indigenous communities. We aim to highlight potential disparities and temporal shifts in both the impact of COVID-19 and vaccine uptake among hospitalized Indigenous populations in Chile. Methods: We conducted an observational analysis utilizing 1,598,492 hospitalization records from 2020 to 2021 based on publicly accessible hospital discharge data spanning 65 healthcare facilities of medium and high complexity funded through the Diagnosis-Related Groups (DRG) mechanism in Chile, representing roughly 70% of the country's total hospitalizations. This was supplemented with publicly available municipal data on COVID-19 vaccinations and socio-demographic variables. We performed logistic regression analysis at 0.05 level of significance to assess the bivariate and multivariable association of Indigenous status with COVID-19 diagnosis and COVID-19 deaths among hospitalized populations. We also performed univariate and multiple linear regression to assess the association of COVID-19 vaccination rate and Indigenous status at the municipality level. In addition, we report the distribution of top 10 secondary diagnoses among hospitalized COVID-19 cases and deaths separately for Indigenous and non-Indigenous populations. Results: Indigenous populations displayed lower adjusted odds for both COVID-19 diagnosis (OR: 0.76, 95% CI: 0.74, 0.77) and death (OR: 0.91, 95% CI: 0.85, 0.97) when compared to non-Indigenous groups. Notably, the adjusted odds ratio for COVID-19 diagnosis in Indigenous populations rose from 0.59 (95% CI: 0.57, 0.61) in 2020 to 1.17 (95% CI: 1.13, 1.21) in 2021. Factors such as the significantly higher median age and greater number of comorbidities in the non-Indigenous hospitalized groups could account for their increased odds of COVID-19 diagnosis and mortality. Additionally, our data indicates a significantly negative adjusted association between COVID-19 vaccination rates and the proportion of Indigenous individuals. Conclusion: Although Indigenous populations initially showed lower odds of COVID-19 diagnosis and mortality, a marked rise in diagnosis odds among these groups in 2021 underscores the urgency of targeted interventions. The observed negative association between the proportion of Indigenous populations and vaccination rates further underscores the necessity to tackle vaccine access barriers and work towards equitable distribution.Publication Socioeconomic inequalities in Chile during the COVID-19 pandemic: A regional analysis of income poverty(2025) Delgado, Iris; Dahal, Sushma; Matute, María Isabel; Rubilar, Paola; Mamelund, Svenn-Erik; Chowell, GerardoThe COVID-19 pandemic caused an unprecedented economic crisis, intensifying poverty levels in Latin America, particularly in Chile. This study examines the short- and long-term socioeconomic impacts of COVID-19 on income poverty in Chile, focusing on regional disparities, rurality, ethnicity, educational attainment, and immigration. Using data from the Chile National Socioeconomic Characterization Survey (CASEN) for 2017, 2020, and 2022, we analyzed poverty trends across the pre-pandemic, pandemic, and post-pandemic periods. We employed spatial clustering techniques with Local Moran's I to detect poverty hotspots and applied logistic regression models to identify key sociodemographic factors associated with these hotspots. Our results reveal stark regional disparities, with disproportionately higher poverty rates among rural populations, Indigenous communities, and individuals with lower education levels or immigrant backgrounds. The proportion of individuals in poverty hotspots rose from 6.8% in 2017 to 8.6% in 2020, before slightly declining to 7.7% in 2022. Although emergency monetary subsidies helped reduce overall poverty from 10.8% in 2020 to 6.5% in 2022, these measures were insufficient to address deep-rooted structural inequalities. Our findings underscore the urgent need for targeted, long-term policies that go beyond temporary financial assistance and tackle systemic disparities linked to rurality, ethnicity, education, and immigration. Such measures are essential for achieving sustainable poverty reduction and fostering inclusive economic growth in Chile.