{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T15:02:14Z","timestamp":1776092534221,"version":"3.50.1"},"reference-count":19,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T00:00:00Z","timestamp":1776038400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T00:00:00Z","timestamp":1776038400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Can J Public Health"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Nirmatrelvir-ritonavir is recommended to prevent severe outcomes due to SARS-CoV-2 infection in high-risk patients. Our objective was to determine if inequities existed in access to nirmatrelvir-ritonavir across sociodemographic groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a population-based ecological study of nirmatrelvir-ritonavir dispenses in Ontario, Canada, forward sortation areas (FSA) from April 4, 2022, to April 3, 2023. Our primary outcome was the FSA-level dispense rate of nirmatrelvir-ritonavir per 100,000 population. A negative binomial model was used to calculate crude and adjusted rate ratios with 95% confidence intervals (CIs) for nine sociodemographic variables (income, visible minority, essential worker, household size, education, citizenship, employment rate, social assistance, and language proficiency), adjusted for seven demographic\/clinical population-level variables (age, sex, comorbidities, immunocompromised, COVID-19 vaccination, long-term care residents, and percent SARS-CoV-2 PCR test positivity).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The final cohort included 513 FSAs, 12,911,594 residents\u2014127,123 (0.98%) who received and 12,784,471 (99.02%) who did not receive nirmatrelvir-ritonavir. There was an 18-fold variation across FSAs, 133\u20132417 prescriptions per 100,000 population. In the adjusted model, dispensing rates were significantly lower in regions with higher proportions of residents with low income (adjusted rate ratio (RR\n                      <jats:sub>adj<\/jats:sub>\n                      )\u2009=\u20090.98 (95% CI 0.97, 1.00,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.014)) and less post-secondary education (RR\n                      <jats:sub>adj<\/jats:sub>\n                      \u2009=\u20090.98 (95% CI 0.97, 1.00,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.044)). Other sociodemographic variables did not have significantly lower nirmatrelvir-ritonavir use.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This province-wide study revealed small inequities in nirmatrelvir-ritonavir dispensing across Ontario neighborhoods with lower income and lower post-secondary education populations associated with less nirmatrelvir-ritonavir use. The findings highlight the importance of addressing barriers for equitable access to therapeutics for future pandemics.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.17269\/s41997-026-01189-8","type":"journal-article","created":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T14:08:45Z","timestamp":1776089325000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluating equitable access based on sociodemographic predictors of nirmatrelvir-ritonavir use during the first year of availability in Ontario, Canada: A population-based ecological study"],"prefix":"10.17269","author":[{"given":"Meagan","family":"Lacroix","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bradley J.","family":"Langford","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cynthia","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jun","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mina","family":"Tadrous","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nick","family":"Daneman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valerie","family":"Leung","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tara","family":"Gomes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lindsay","family":"Friedman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Daley","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin A.","family":"Brown","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3666-7005","authenticated-orcid":false,"given":"Kevin L.","family":"Schwartz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,4,13]]},"reference":[{"issue":"2","key":"1189_CR1","doi-asserted-by":"publisher","DOI":"10.1002\/jmv.28441","volume":"95","author":"B Amani","year":"2023","unstructured":"Amani, B., & Amani, B. (2023). Efficacy and safety of nirmatrelvir\/ritonavir (Paxlovid) for COVID-19: A rapid review and meta-analysis. Journal of Medical Virology, 95(2), Article e28441.","journal-title":"Journal of Medical Virology"},{"key":"1189_CR2","unstructured":"Apply for OHIP and get a health card. (2024). Government of Ontario. Available from: https:\/\/www.ontario.ca\/page\/apply-ohip-and-get-health-card#section-2 (accessed 29 October 2024). (n.d.)."},{"issue":"43","key":"1189_CR3","doi-asserted-by":"publisher","first-page":"1359","DOI":"10.15585\/mmwr.mm7143a2","volume":"71","author":"TK Boehmer","year":"2022","unstructured":"Boehmer, T. K., Koumans, E. H., Skillen, E. L., Kappelman, M. D., Carton, T. W., Patel, A., August, E. M., Bernstein, R., Denson, J. L., Draper, C., Gundlapalli, A. V., Paranjape, A., Puro, J., Rao, P., Siegel, D. A., Trick, W. E., Walker, C. L., & Block, J. P. (2022). Racial and ethnic disparities in outpatient treatment of COVID-19\u2014United States, January-July 2022. 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Dispensing of oral antiviral drugs for treatment of COVID-19 by zip code-level social vulnerability\u2014United States, December 23, 2021-May 21, 2022. MMWR. Morbidity and Mortality Weekly Report, 71(25), 825\u2013829.","journal-title":"MMWR. Morbidity and Mortality Weekly Report"},{"issue":"15","key":"1189_CR6","doi-asserted-by":"publisher","first-page":"1397","DOI":"10.1056\/NEJMoa2118542","volume":"386","author":"J Hammond","year":"2022","unstructured":"Hammond, J., Leister-Tebbe, H., Gardner, A., Abreu, P., Bao, W., Wisemandle, W., Baniecki, M., Hendrick, V. M., Damle, B., Sim\u00f3n-Campos, A., Pypstra, R., Rusnak, J. M., EPIC-HR Investigators. (2022). Oral Nirmatrelvir for High-Risk, Nonhospitalized Adults with Covid-19. The New England Journal of Medicine, 386(15), 1397\u20131408.","journal-title":"The New England Journal of Medicine"},{"key":"1189_CR7","doi-asserted-by":"crossref","unstructured":"Komorowski, Tseng, & others. (2022). 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Journal of General Internal Medicine, 37(10), 2505\u20132513.","journal-title":"Journal of General Internal Medicine"}],"container-title":["Canadian Journal of Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.17269\/s41997-026-01189-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.17269\/s41997-026-01189-8","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.17269\/s41997-026-01189-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T14:08:53Z","timestamp":1776089333000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.17269\/s41997-026-01189-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,13]]},"references-count":19,"alternative-id":["1189"],"URL":"https:\/\/doi.org\/10.17269\/s41997-026-01189-8","relation":{},"ISSN":["0008-4263","1920-7476"],"issn-type":[{"value":"0008-4263","type":"print"},{"value":"1920-7476","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,13]]},"assertion":[{"value":"25 June 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 March 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 April 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study has ethics research board approval from Public Health Ontario (2022-015.01).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Consent requirements were waived by the Research Ethics Board.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"Not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Gomes has received a stipend from Indigenous Services Canada for their role on the Drugs and Therapeutics Advisory Committee. No other competing interests were declared.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}