Correlation Analysis Of Global Health Security Index With COVID-19 Pandemic And Prevention And Control Effects

Background:The impact of the COVID-19 pandemic has made all countries and regions deeply realize the strategic position of global public health security.The Global Health Security Index is one of the tools used to assess the capacity of global public health security.Current studies on GHSI mainly analyzed the correlation between GHSI and COVID-19 pandemic,and explored the influence of policy,environment and other factors on this correlation.However,there is a lack of attention to the social determinants of health,such as geographical environment,socio-economics,health and sanitation systems,epidemic prevention and control policies and measures,digital information level,behaviour and lifestyle,population age,etc.Studies have shown that social determinants of health were at the root of health inequalities and related to both communicable and non-communicable diseases.Even the same disease or health problem showed different distribution in different countries or regions with different social backgrounds.Objectives:To screen potential modifiers accordingly by analyzeing the association between GHSI and COVID-19 morbidity,as well as social determinants of health and COVID-19 morbidity.To analyze the effect modification of social determinants of health on the association between GHSI and COVID-19 morbidity at different levels.According to the results of the empirical study,some suggestions were provided for reducing the risk of disease and improving the effectiveness of GHSI assessment in countries(regions).Methods:We conducted a fixed-cohort study based on observational data from 134 countries in a publicly available database.Multiple linear regression models and generalized linear mixed effects models were used to explore associations between six core dimensions of GHSI(prevention,detection reporting,rapid response,health system,compliance with international norms,and risk environment)and COVID-19 incidence(COVID-19 incidence in 2022 and COVID-19 incidence in 2022 per quarter),and associations between social determinants of health and the incidence of COVID19 to screen for relevant variables.Further,effect modification analysis was used to explore the effect modification of social determinants of health on the association between GHSI and COVID-19 morbidity at different levels.This paper aims to explore and analyze the effectiveness of GHSI assessment and its influencing factors.Results:1.Association of GHSI with the incidence of COVID-19GHSI prevention,detection reporting,rapid response,and compliance with international norms in 134 countries were not significantly associated with fullyear and quarterly COVID-19 incidence in 2022.There was a significant positi-ve association between the risk environment and the annual and quarterly incidence of COVID-19 in 2022[IRR=1.112,95%confidence interval(CI):1.083-1.141;IRR=1.040,95%CI:1.018～1.063].There was a significant positive associatio-n between health systems and the incidence of COVID-19 in 2022(IRR=1.014,95%CI:1.002～1.026).2.Association of social determinants of health with the incidence of COVID-19Income level,whether the society was aging,epidemic experience(SARS and MERS),availability of epidemiological investigation data,life expectancy,northern and southern hemispheres,policy stringency index,and smoking rate were all significantly correlated with COVID-19 incidence.High-income countries had higher incidence of COVID-19 in 2022 and quarterly compared to lower-income countries,with coefficients of 0.930(95%CI:0.407-1.453)and 0.892(95%CI:0.371-1.413).Compared with countries with non-aging societies,countries with aging societies have higher incidence of COVID-19 in 2022 and each quarter,with coefficients of 0.994(95%CI:0.434-1.554)and 1.593(95%CI:0.9472.238).Compared with countries without SARS and MERS epidemics,countries with SARS and MERS epidemics had higher COVID-19 incidence per quarter in 2022(β=0.345,95%CI:0.032-0.659).The incidence of COVID-19 per quarter in 2022 was higher in countries where epidemiological investigation data was available than in countries where epidemiological investigation data was not available(β=0.349,95%CI:0.073-0.624).The incidence of COVID-19 increased with the increase of life expectancy in 2022 and each quarter,with coefficients of 0.183(95%CI:0.1350.230)and 0.098(95%CI:0.037-0.159).Countries in the Southern Hemisphere had a higher incidence of COVID-19 in 2022 compared to countries in the Northern Hemisphere(β=0.772,95%CI:0.315-1.229).The quarterly incidence of COVID-19 in 2022 decreased as the quarterly policy stringency index in 2022 increased(β=0.010,95%CI:-0.016-0.003).The incidence of COVID-19 in 2022 increased with the increase in male smoking rate(β=0.022,95%CI:0.009-0.035).3.Effect modification of social determinants of health on the association between GHSI and the incidence of COVID-19Epidemiological experience(SARS and MERS)had a positive effect modifier on the association between health systems and COVID-19 incidence in 2022.The strength of the health system effect on COVID-19 incidence in 2022 was more pronounced in countries with no experience of SARS and MERS epidemics(IRR=1.016,95%CI:1.003～1.029).Northern and southern hemispheres,epidemic experience(SARS and MER S),and income level had positive effects on the association between risk envir onment and COVID-19 incidence in 2022.The strength of the effect of the ris k environment on COVID-19 incidence in 2022 was more pronounced in count ries in the Southern Hemisphere,countries with no experience of SARS and M ERS epidemics,or high-income countries(IRR=1.117,95%CI:1.087-1.148;IRR=1.115,95%CI:1.086-1.145;IRR=1.127,95%CI:1.103～1.152).Conclusions:1.GHSI prevention,reporting of tests,rapid response,and compliance with international norms were not significantly associated with COVID-19 incidence for the full year or each quarter in 2022.There was a significant positive association between health systems and COVID-19 incidence in 2022.The risk environment was significantly positively associated with the incidence of COVID-19 in 2022 for both the full year and each quarter.The correlation analysis between the six GHSI groups and the incidence of COVID-19 showed that the GHSI score could not effectively reflect the epidemic prevention and control effect of a country or region,which may be affected by other influencing factors,suggesting that the assessment of GHSI was lack of effectiveness.2.Income level,whether there was an aging society,epidemic experience(SARS and MERS),availability of epidemiological investigation data,life expectancy,northern and southern hemispheres,policy stringency index,and smoking rate were all significantly correlated with COVID-19 incidence.This suggested that the above social determinants of health may be potential modifiers for the association between GHSI and COVID-19 morbidity.3.Epidemiological experience(SARS and MERS)modifies the positive effect of health system associations with COVID-19 incidence in 2022.The strength of the health system effect on COVID-19 incidence in 2022 was stronger in countries with no SARS and MERS epidemic experience,suggesting that epidemic experience contributed to strengthening health systems.4.Northern and southern hemispheres,epidemic experience(SARS and MERS),and income level had positive modifiers on the association between risk environment and COVID-19 incidence.The impact of risk environments on COVID-19 incidence in 2022 is more pronounced in countries in the Southern Hemisphere,countries that have not experienced epidemics of SARS and MERS and high-income countries.