The social determinants of health and health outcomes among adults during the COVID-19 pandemic: A systematic review

Public Health Nurs. 2021 Nov;38(6):942-952. doi: 10.1111/phn.12959. Epub 2021 Aug 17.


Objective: To synthesize the best available evidence on the relationship between the social determinants of health and health outcomes among adults during the COVID-19 pandemic.

Introduction: COVID-19 has created widespread global transmission. Rapid increase in individuals infected with COVID-19 prompted significant public health responses from governments globally. However, the social and economic impact on communities may leave some individuals more susceptible to the detrimental effects.

Methods: A three-step search strategy was used to find published and unpublished papers. Databases searched included: MEDLINE, CINAHL, EMBASE, and Google Scholar. All identified citations were uploaded into Endnote X9, with duplicates removed. Methodological quality of eligible papers was assessed by two reviewers, with meta-synthesis conducted in accordance with JBI methodology.

Results: Fifteen papers were included. Three synthesized-conclusions were established (a) Vulnerable populations groups, particularly those from a racial minority and those with low incomes, are more susceptible and have been disproportionately affected by COVID-19 including mortality; (b) Gender inequalities and family violence have been exacerbated by COVID-19, leading to diminished wellbeing among women; and (c) COVID-19 is exacerbating existing social determinants of health through loss of employment/income, disparities in social class leading to lack of access to health care, housing instability, homelessness, and difficulties in physical distancing.

Conclusion: Reflection on social and health policies implemented are necessary to ensure that the COVID-19 pandemic does not exacerbate health inequalities into the future.

Keywords: COVID-19; health inequalities; pandemic; social determinants; systematic review.

Publication types

  • Systematic Review

MeSH terms

  • Adult
  • COVID-19* / epidemiology
  • Health Status Disparities*
  • Humans
  • Pandemics*
  • Social Determinants of Health*
  • Socioeconomic Factors