CMPH Journal

Introduction

Communicable diseases are transmissible, often caused by microorganisms such as viruses, fungi, parasites, and bacteria, and are transmitted directly from infected individuals via physical contact, treatment with contaminated medical instruments, or indirectly by sharing water, air, or food with healthy individuals [1]. Worldwide known communicable diseases include syphilis, Tuberculosis (TB), Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS), Coronavirus Disease 2019 (COVID-19), cholera, typhoid, and salmonellosis [2]. The history of communicable diseases can be traced back to 1918’s, when the contact tracing of influenza outbreak was more than fifty million people in the United States of America (USA). There is an escalation noted in the prevalence of communicable diseases, such as there are 42.3 million cases of HIV and around 6.3 million deaths reported due to HIV in 2023. After COVID-19, 1.5 million die each year from TB becoming the second infectious killer [1].

Communicable disease in minority areas is a major global concern. Worldwide, the prevalence ratio of communicable disease is high in minority populations i.e., sub-Saharan Africa and in some regions of Eastern Europe and Asia [2]. Not limited to that, the prevalence of HIV/AIDS is also increasing among the Hispanics, Blacks, and Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) minorities of the USA along with high literacy rates, periodic awareness programs, and the facilities available for org/10.29011/2577-2228.100508

treatment and prevention [3]. Recently, it has been reported that each year around seventy-eight million people are struggling with Sexually Transmitted Infections (STIs) like gonorrhoea around the globe and around eight hundred and twenty thousand in the USA [3]. In terms of COVID-19, the morbidity rate was significantly higher in minority populations [4]. The ratio of TB is also higher in racial and ethnic minorities in other countries like Vietnam [5].

The major impacts of communicable disease include limited access to available quality healthcare, lack of awareness, discrimination in communities, inadequate housing, limited availability of prevention measures, and financial burden in the prevalence in minority communities [4]. Whereas available still the minority communities are unable to bear the expensive healthcare costs in the prevention associated with communicable diseases. For example, the costly hospital expenditures i.e., frequent medical consultation, diagnosis, treatments, and stay [5]. Not limited to health, the financial burden has a direct impact on education, awareness, and cultural etiquette [6]. Despite that, infected individuals often seek help in obtaining accurate and culturally appropriate information and understanding transmission, prevention, and treatment [7,8].

Very limited knowledge is available on the socioeconomic impact of infectious diseases in minority populations to emphasize the effectiveness of educational interventions, culturally sensitive outreach programs, and community-based initiatives. It could be the considerable reason for the lack of awareness of preventive measures in minority communities. In this context, the current review aims to critically examine the existing literature on the causes of the prevalence of communicable diseases in minority groups and to recommend strategies for improving health.

Methodology

A methodological framework, Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines are followed [9] for the current systematic analysis.

Search Sources and Strategies

Relevant literature on exploring the socioeconomic effects of infectious diseases on marginalized groups was thoroughly searched on PubMed, PubMed Central (PMC), Medline, PubMed Medical Subject Heading (PubMed (MeSH)), and PubMed Advance (PubMed (Advance)) databases by using specific keywords, terms, and phrases conjoined with Boolean operators “AND”.

A total of n=418 were selected from PubMed, n=3 from PubMed (MeSH), n=416 from PubMed (Advance), and n=2 from Medline, as shown in Table 1.

Table 1:  Article search strategy. 

Inclusion and Exclusion Criteria

The studies explored the impact of communicable diseases on health, education, social life, and financial challenges in minority groups in English from 2019-2023 were included. Whereas, the articles about non-minority populations having access to healthcare published before 2019 are excluded.

Selection Process

The guidelines of PRISMA for the selection of relevant articles were followed. Irrelevant studies were excluded from identification, Screening, and eligibility processes. In the identification, a total of n=839 articles were selected, in which duplicate records n=419 were excluded. The other n=14 studies were assessed using quality appraisal tools, where n=5 articles did not pass the RoB assessment. In screening, among the remaining n=420 articles, n=405 were excluded because of unrelated titles n=326, and unrelated abstracts n=79. A total of n=15 articles were selected for full-text screening (reports Sought for retrieval) and assessment of eligibility, in which n=6 articles were excluded. The remaining n=9 articles were accepted for the current study in which n=7 were observational studies, n=1 systematic review, and n=1 randomized study. Figure 1 shows the schematic filtration of included and excluded studies.

Figure 1: The selection criteria for the included articles.

Quality Appraisal of the Studies

The researcher initially refined the selected articles on sample size, socioeconomic indicators, and outcomes. A second and third reviewers verified the accuracy and completeness of all abstracted data. Furthermore, a modified version of the AMSTAR checklist was used to determine the studies’ RoB. The other researchers were assigned to categorize the articles into low, unclear, or high RoB ratings. A review with a low RoB rating indicates confidence that the findings accurately reflect the socioeconomic effects of infectious diseases on minority populations. An appraisal with an ambiguous or unclear RoB may be subjected to a specific RoB but presumably insufficient to declare that conclusions are incorrect. A review with a high RoB includes substantial defects, including errors resulting in design, behavior, or exploration that could undermine its findings. Besides, the researchers applied other assessment tools like the Newcastle-Ottawa scale, the SANRA checklist, and the Cochrane Bias Assessment Tool to determine the methodological quality and studies’ with RoB. A consensus was reached among all the researchers in case of any disagreement.

Data Collection Process

The required information was extracted from the selected studies including author name, publication year, location and setting of the study, participants, the kind of infectious disease, outbreak year, design of the study, outcomes, analyzed variables, tools or software, and data on the socioeconomic effects. For consistency, estimated costs were converted to U.S. Dollars (USD) by using the web-based CCEMG - EPPI-Centre Cost Converter (v.1.6) tool, leveraging a similar baseline year as indicated in the initial research and the International Monetary Fund source dataset for buying power parity values. Wherever possible, consensus was sought to resolve any disagreements.

Due to heterogeneity in the systematic review, data analysis was qualitative rather than meta-analytic. Statistical Package of Social Science (SPSS, version: 25) was used for descriptive statistics to analyze the data. The frequency and percentage were used to investigate the categorical data, and the mean and standard deviation to assess numerical data.

Results

Study Identification and Selection

The selected articles were arranged by using EndNote (version 20). At first, Replicas were filtered by the “Find and Remove Duplicate References eliminated” tool, and then the remaining articles were manually screened and removed articles incorrectly entered into multiple databases. A careful evaluation of the eligibility of each article was assessed in two steps. Firstly, removing duplicates via screening and evaluating the relevant search results in titles and abstracts. Secondly, the complete text of the articles was retrieved and examined considering the inclusion criteria. Another researcher cross-validated the articles by considering the inclusion and exclusion criteria to avoid any disagreement.

Outcomes

The researcher methodically combined the information of each included article, required for this study. For example, Folayan et al. investigated socioeconomic inequality, health inequality, and psychological distress [17], whereas, Edmunds et al. worked on unequal distribution, unemployment, drug abuse, and limited access to healthcare i.e., Hepatitis C (HCV) [10]. A study conducted by Tuan Abdullah et al. investigated unemployment, career development, and the disgrace of living with HIV [16]. Mulsby et al. assessed the pervasiveness of HIV and unequal access to health and education [15]. Wang et al. examined Medicaid insurance, hepatitis B (HBV) testing rates, and the cost of antiviral therapy [13]. Litvinenko et al. measured the prevalence and incidence ratios of TB [14]. Fletcher et al. measured the socioeconomic factors, unemployment, social isolation, and racism affecting women living with HIV [12]. Raj et al. examined the reasons for STI, sexual risk categorization, housing, and employment [11]. PerezMorente et al. investigated the infection rates, odds ratios (OR), and confidence intervals (C.I.s) for STIs [18].

Study Characteristics

The various characteristics of the included nine articles were carefully analyzed, as shown in Table 2. Firstly, each study was examined by location i.e., one study was conducted worldwide whereas other studies were conducted in specific areas like Washington DC, South Australia, Granada Spain, South USA, Sacramento County, Baltimore, Malaysia, and Nigeria. Secondly, different methodological approaches were used such as systematic review (n=1), nonrandomized controlled trials (n=1), and observational study (n=7). The sample sizes ranged differently between twelve (n=12) and eight hundred and sixty-two thousand (n=862,000) participants. Thirdly, the population included people living in the poorest areas with higher rates of unemployment, Immigrant populations, Black Heterosexual men, AfricanAmerican women, and Asian origin groups. Studies included the socioeconomic impacts of communicable diseases in minority populations i.e., the prevalence of HIV and unemployment among Black gay Men (n=1), and disparities in health among others.

Asian people grappling with chronic HBV (n=1), economic crisis, and STIs (n=1), TB’s burden among vulnerable groups (n=1), career and relationship problems experienced by HIV (n=1), socioeconomic burden of HCV (n=1), socioeconomic inequity and health disparities, and transgender life quality (n=1), employment requires making employment needs (MEN) to minimize the risk of HIV/STI among Black heterosexual men (n=1), and ethical problems and lessons with Black women low-earning with HIV (n=1).

Table 2: Eligible articles.