The role of vaccination, underlying health conditions, and working in healthcare in the socioeconomic disparities in COVID-19 hospitalization: a mediation analysis using interventional effect models

Cavillot, Lisa;Moerkerke, Beatrijs;Devleesschauwer, Brecht;Ghattas, Jinane;De Pauw, Robby;et.al.
(2026) BMC Infectious Diseases — Vol. 26, n° 1, p. 15p (2026)

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Authors
  • Cavillot, LisaUCLouvain
    Author
  • Moerkerke, Beatrijs
    Author
  • Devleesschauwer, Brecht
    Author
  • Ghattas, JinaneUCLouvain
    Author
  • Speybroeck, NikoUCLouvain
    Author
  • De Pauw, Robby
    Author
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Abstract
Background: Prior research has established an association between socioeconomic determinants and COVID-19 hospitalization rates. This study explores the potential mediation of this association by vaccination status, underlying health conditions, and working in healthcare. Methods: We conducted a retrospective cohort study including 111,159 and 337,232 adults living in the Walloon or Brussels regions in Belgium with a confirmed SARS-CoV-2 infection during the Delta-predominant period (1 September 2021 to 22 December 2021) and the Omicron-predominant period (4 January 2022 to 1 September 2022), respectively. Data on COVID-19-related hospital admissions, education, vaccination, underlying health conditions, and individuals working in healthcare were retrieved from multiple national registers, linked at an individual level using the Belgian social security number. Mediation analyses using interventional effect models were used to assess the mediation role of vaccination, underlying health conditions, and working in healthcare in the relationship between education and COVID-19 hospitalization. Results: Shifting from moderate or high education to low education increased the probability of COVID-19 hospitalization by 0.694% points (95% CI 0.561–0.819) during the Delta period and 0.547% points (95% CI 0.491–0.603) during the Omicron period. Most of this increase was due to the direct effect of education, accounting for 84.6% of the total effect during Delta and 93.1% during Omicron. During the Delta period, education disparities in COVID-19 hospitalization were partially mediated by vaccination (10.1%) and underlying health conditions (6.3%). During the Omicron period, education disparities in COVID-19 hospitalization were partially mediated by underlying health conditions (4.8%), vaccination (1.4%), and working in healthcare (0.7%).
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Cavillot, L., Moerkerke, B., Devleesschauwer, B., Ghattas, J., van Loenhout, J. A. F., Van den Borre, L., Speybroeck, N., Loeys, T., & De Pauw, R. (2026). The role of vaccination, underlying health conditions, and working in healthcare in the socioeconomic disparities in COVID-19 hospitalization: a mediation analysis using interventional effect models. BMC Infectious Diseases, 26(1), 15p. https://doi.org/10.1186/s12879-026-12907-5 (Original work published 2026)