Modeling the role of healthcare access inequalities in epidemic outcomes

Oscar  Patterson-Lomba; Muntaser  Safan; Sherry  Towers; Jay  Taylor

doi:10.3934/mbe.2016028

Article Contents

2016, Volume 13, Issue 5: 1011-1041. Doi: 10.3934/mbe.2016028

This issue Previous Article Epidemic characteristics of two classic models and the dependence on the initial conditions Next Article Development of a computational model of glucose toxicity in the progression of diabetes mellitus

Modeling the role of healthcare access inequalities in epidemic outcomes

1.
Harvard T.H. Chan School of Public Health, Department of Biostatistics, Boston, MA
2.
SAL MCMSC, School of Human Evolution and Social Change, Arizona State University, Tempe, AZ
3.
School of Mathematical and Statistical Sciences, Arizona State University, Tempe, AZ

Received: August 2015

Revised: April 2016

Published: July 2016

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Abstract

Urban areas, with large and dense populations, offer conditions that favor the emergence and spread of certain infectious diseases. One common feature of urban populations is the existence of large socioeconomic inequalities which are often mirrored by disparities in access to healthcare. Recent empirical evidence suggests that higher levels of socioeconomic inequalities are associated with worsened public health outcomes, including higher rates of sexually transmitted diseases (STD's) and lower life expectancy. However, the reasons for these associations are still speculative. Here we formulate a mathematical model to study the effect of healthcare disparities on the spread of an infectious disease that does not confer lasting immunity, such as is true of certain STD's. Using a simple epidemic model of a population divided into two groups that differ in their recovery rates due to different levels of access to healthcare, we find that both the basic reproductive number ($\mathcal{R}_{0}$) of the disease and its endemic prevalence are increasing functions of the disparity between the two groups, in agreement with empirical evidence. Unexpectedly, this can be true even when the fraction of the population with better access to healthcare is increased if this is offset by reduced access within the disadvantaged group. Extending our model to more than two groups with different levels of access to healthcare, we find that increasing the variance of recovery rates among groups, while keeping the mean recovery rate constant, also increases $\mathcal{R}_{0}$ and disease prevalence. In addition, we show that these conclusions are sensitive to how we quantify the inequalities in our model, underscoring the importance of basing analyses on appropriate measures of inequalities. These insights shed light on the possible impact that increasing levels of inequalities in healthcare access can have on epidemic outcomes, while offering plausible explanations for the observed empirical patterns.

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Mathematics Subject Classification: Primary: 92D25, 92D30; Secondary: 92B99.

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