{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T18:56:40Z","timestamp":1788375400830,"version":"build-2803163510"},"reference-count":40,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2022,2,24]],"date-time":"2022-02-24T00:00:00Z","timestamp":1645660800000},"content-version":"unspecified","delay-in-days":23,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2022,1,31]]},"published-print":{"date-parts":[[2022,2]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Association of educational status, as marker of socioeconomic status, with COVID-19 outcomes has not been well studied. We performed a hospital-based cross-sectional study to determine its association with outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Successive patients of COVID-19 presenting at government hospital were recruited. Demographic and clinical details were obtained at admission, and in-hospital outcomes were assessed. Cohort was classified according to self-reported educational status into group 1: illiterate or \u2264primary; group 2: higher secondary; and group 3: some college. To compare intergroup outcomes, we performed logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      4645 patients (men 3386, women 1259) with confirmed COVID-19 were recruited. Mean age was 46\u00b118 years, most lived in large households and 30.5% had low educational status. Smoking or tobacco use was in 29.5%, comorbidities in 28.6% and low oxygen concentration (SpO\n                      <jats:sub>2<\/jats:sub>\n                      &lt;95%) at admission in 30%. Average length of hospital stay was 6.8\u00b13.7 days, supplemental oxygen was provided in 18.4%, high flow oxygen or non-invasive ventilation 7.1% and mechanical ventilation 3.6%, 340 patients (7.3%) died. Group 1 patients had more tobacco use, hypoxia at admission, lymphocytopaenia, and liver and kidney dysfunction. In group 1 versus groups 2 and 3, requirement of oxygen (21.6% vs 16.7% and 17.0%), non-invasive ventilation (8.0% vs 5.9% and 7.1%), invasive ventilation (4.6% vs 3.5% and 3.1%) and deaths (10.0% vs 6.8% and 5.5%) were significantly greater (p&lt;0.05). OR for deaths were higher in group 1 (1.91, 95% CI 1.46 to 2.51) and group 2 (1.24, 95% CI 0.93 to 1.66) compared with group 3. Adjustment for demographic and comorbidities led to some attenuation in groups 1 (1.44, 95% CI 1.07 to 1.93) and 2 (1.38, 95% CI 1.02 to 1.85); this persisted with adjustments for clinical parameters and oxygen support in groups 1 (1.38, 95% CI 0.99 to 1.93) and 2 (1.52, 95% CI 1.01 to 2.11).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Low educational status patients with COVID-19 in India have significantly greater adverse in-hospital outcomes and mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>REF\/2020\/06\/034036.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-055403","type":"journal-article","created":{"date-parts":[[2022,2,25]],"date-time":"2022-02-25T11:40:45Z","timestamp":1645789245000},"page":"e055403","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":14,"title":["Educational status and COVID-19 related outcomes in India: hospital-based cross-sectional study"],"prefix":"10.1136","volume":"12","author":[{"given":"Arvind K","family":"Sharma","sequence":"first","affiliation":[{"name":"Department of Community Medicine, RUHS College of Medical Sciences, Jaipur, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8356-3137","authenticated-orcid":false,"given":"Rajeev","family":"Gupta","sequence":"additional","affiliation":[{"name":"Academic Research Development Unit, Rajasthan University of Health Sciences, Jaipur, Rajasthan, India"},{"name":"Department of Medicine, Eternal Heart Care Centre and Research Institute, Jaipur, Rajasthan, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vaseem Naheed","family":"Baig","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, RUHS College of Medical Sciences, Jaipur, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veer Teja","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, RUHS College of Medical Sciences, Jaipur, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Surabhi","family":"Chakraborty","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, RUHS College of Medical Sciences, Jaipur, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jagdish P","family":"Sunda","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, RUHS College of Medical Sciences, Jaipur, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prahalad","family":"Dhakar","sequence":"additional","affiliation":[{"name":"Department of Medicine, RUHS College of Medical Sciences, Jaipur, Rajasthan, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiv Prakash","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, RUHS College of Medical Sciences, Jaipur, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raja Babu","family":"Panwar","sequence":"additional","affiliation":[{"name":"Academic Research Development Unit, Rajasthan University of Health Sciences, Jaipur, Rajasthan, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vishwa Mohan","family":"Katoch","sequence":"additional","affiliation":[{"name":"ICMR NASI Chair in Public Health Research, Rajasthan University of Health Sciences, Jaipur, Rajasthan, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,2,25]]},"reference":[{"key":"2025121407523377000_12.2.e055403.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)31089-8"},{"key":"2025121407523377000_12.2.e055403.2","doi-asserted-by":"crossref","first-page":"1255","DOI":"10.1016\/S1473-3099(20)30581-8","article-title":"Observations of the global epidemiology of COVID-19 from the prepandemic period using web-based surveillance: a cross-sectional analysis","volume":"20","author":"Dawood","year":"2020","journal-title":"Lancet Infect Dis"},{"key":"2025121407523377000_12.2.e055403.3","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0248336","article-title":"Social determinants of COVID-19 incidence and outcomes: a rapid review","volume":"16","author":"Upshaw","year":"2021","journal-title":"PLoS One"},{"key":"2025121407523377000_12.2.e055403.4","doi-asserted-by":"crossref","first-page":"100630","DOI":"10.1016\/j.eclinm.2020.100630","article-title":"Ethnicity and clinical outcomes in COVID-19: a systematic review and meta-analysis","volume":"29-30","author":"Sze","year":"2020","journal-title":"EClinicalMedicine"},{"key":"2025121407523377000_12.2.e055403.5","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)31380-5"},{"key":"2025121407523377000_12.2.e055403.6","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp2023616"},{"key":"2025121407523377000_12.2.e055403.7","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp2008628"},{"key":"2025121407523377000_12.2.e055403.8","doi-asserted-by":"crossref","unstructured":"Leon DA , Poverty WG . Poverty, inequality and health: an international perspective. Oxford: Oxford University Press, 2001.","DOI":"10.1093\/acprof:oso\/9780192631961.003.0001"},{"key":"2025121407523377000_12.2.e055403.9","doi-asserted-by":"crossref","unstructured":"Marmot M , Wilkinson R . Social determinants of health. Oxford: Oxford University Press, 2005.","DOI":"10.1093\/acprof:oso\/9780198565895.001.0001"},{"key":"2025121407523377000_12.2.e055403.10","unstructured":"Gupta R , Joseph P , Rosengren A , et al . Location and level of care, education, availability of medicines and cardiovascular mortality. In: Fuster V , Narula J , Vaishnava P , eds. Hurst\u2019s The Heart. 15th Ed. New York: McGraw Hill, 2022."},{"key":"2025121407523377000_12.2.e055403.11","doi-asserted-by":"crossref","unstructured":"Bollyky TJ . Plagues and the paradox of progress. Cambridge, MA: The MIT Press, 2018.","DOI":"10.7551\/mitpress\/11750.001.0001"},{"key":"2025121407523377000_12.2.e055403.12","doi-asserted-by":"publisher","DOI":"10.1111\/ALL.14657"},{"key":"2025121407523377000_12.2.e055403.13","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2020.34578","article-title":"Association of social and economic inequality with coronavirus disease 2019 incidence and mortality across US counties","volume":"4","author":"Liao","year":"2021","journal-title":"JAMA Netw Open"},{"key":"2025121407523377000_12.2.e055403.14","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2020.113554"},{"key":"2025121407523377000_12.2.e055403.15","doi-asserted-by":"publisher","DOI":"10.7326\/m20-6306"},{"key":"2025121407523377000_12.2.e055403.16","unstructured":"Ritchie H , Ortiz-Ospina E , Beltekian D . India: coronavirus pandemic country profile. Available: https:\/\/ourworldindata.org\/coronavirus\/country\/india [Accessed 5 May 2021]."},{"key":"2025121407523377000_12.2.e055403.17","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1016\/j.dsx.2021.01.005","article-title":"Macrolevel association of COVID-19 with non-communicable disease risk factors in India","volume":"15","author":"Gaur","year":"2021","journal-title":"Diabetes Metab Syndr"},{"key":"2025121407523377000_12.2.e055403.18","doi-asserted-by":"publisher","DOI":"10.1016\/j.puhe.2020.06.011"},{"key":"2025121407523377000_12.2.e055403.19","doi-asserted-by":"publisher","DOI":"10.1101\/2020.06.02.20106310"},{"key":"2025121407523377000_12.2.e055403.20","first-page":"86","article-title":"Association of SARS CoV-2 cycle threshold (CT) with clinical outcomes: a hospital-based study","volume":"69","author":"Sharma","year":"2021","journal-title":"J Assoc Physicians India"},{"key":"2025121407523377000_12.2.e055403.21","unstructured":"Government of India,, Ministry of Health and Family Welfare . Clinical management protocol: COVID-19. Available: http:\/\/www.rajswasthya.nic.in\/PDF\/COVID%20-19\/FOR%20HOSPITALS\/27.06.2020.pdf [Accessed 30 Apr 2021]."},{"key":"2025121407523377000_12.2.e055403.22","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1038\/s41371-018-0117-3","article-title":"Emerging trends in hypertension epidemiology in India","volume":"33","author":"Gupta","year":"2019","journal-title":"J Hum Hypertens"},{"key":"2025121407523377000_12.2.e055403.23","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)00634-6"},{"key":"2025121407523377000_12.2.e055403.24","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2021-004959"},{"key":"2025121407523377000_12.2.e055403.25","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.1377\/hlthaff.2020.00598","article-title":"Disparities in outcomes among COVID-19 patients in a large health care system in California","volume":"39","author":"Azar","year":"2020","journal-title":"Health Aff"},{"key":"2025121407523377000_12.2.e055403.26","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-021-10207-y","article-title":"Socioeconomic disparity and the risk of contracting COVID-19 in South Korea: an NHIS-COVID-19 database cohort study","volume":"21","author":"Oh","year":"2021","journal-title":"BMC Public Health"},{"key":"2025121407523377000_12.2.e055403.27","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(21)00632-2"},{"key":"2025121407523377000_12.2.e055403.28","doi-asserted-by":"publisher","DOI":"10.1126\/science.abg5298"},{"key":"2025121407523377000_12.2.e055403.29","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2021.34147","article-title":"Disparities in COVID-19 outcomes by race, ethnicity, and socioeconomic status: a Systematic-Review and meta-analysis","volume":"4","author":"Magesh","year":"2021","journal-title":"JAMA Netw Open"},{"key":"2025121407523377000_12.2.e055403.30","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m2980"},{"key":"2025121407523377000_12.2.e055403.31","unstructured":"RECOVERY: randomized evaluation of COVID-19 therapy. news. Oxford. Nuffield department of population health, 2021. Available: https:\/\/www.recoverytrial.net\/news [Accessed 6 May 2021]."},{"key":"2025121407523377000_12.2.e055403.32","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-publhealth-031210-101218"},{"key":"2025121407523377000_12.2.e055403.33","doi-asserted-by":"crossref","DOI":"10.1016\/S2468-2667(20)30144-4","article-title":"Education: a neglected social determinant of health","volume":"5","year":"2020","journal-title":"Lancet Public Health"},{"key":"2025121407523377000_12.2.e055403.34","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.309.6965.1332"},{"key":"2025121407523377000_12.2.e055403.35","doi-asserted-by":"crossref","first-page":"hpw169","DOI":"10.1093\/ajh\/hpw169","article-title":"Association of household wealth index, educational status, and social capital with hypertension awareness, treatment, and control in South Asia","volume":"30","author":"Gupta","year":"2017","journal-title":"Am J Hypertens"},{"key":"2025121407523377000_12.2.e055403.36","unstructured":"Smedley BD , Syme SL . Promoting health: intervention strategies from social and behavioral research. Washington: National Academy Press. Institute of Medicine, 2000."},{"key":"2025121407523377000_12.2.e055403.37","first-page":"61","article-title":"Health systems in Post-Covid-19 era: strengthening primary care and district hospital","volume":"5","author":"Gupta","year":"2020","journal-title":"RUHS J Health Sciences"},{"key":"2025121407523377000_12.2.e055403.38","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.8051"},{"key":"2025121407523377000_12.2.e055403.39","first-page":"141","article-title":"SARS-CoV-2 variants of concern and changing trends of COVID-19 in India and Rajasthan: epidemiological perspective","volume":"6","author":"Gupta","year":"2021","journal-title":"RUHS J Health Sciences"},{"key":"2025121407523377000_12.2.e055403.40","doi-asserted-by":"publisher","DOI":"10.1136\/jech-2020-214297"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2021-055403","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T15:52:47Z","timestamp":1765727567000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2021-055403"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2]]},"references-count":40,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2022,2,25]]},"published-print":{"date-parts":[[2022,2]]}},"alternative-id":["10.1136\/bmjopen-2021-055403"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2021-055403","relation":{"has-preprint":[{"id-type":"doi","id":"10.1101\/2021.05.17.21257364","asserted-by":"object"}]},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2]]}}}