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Objectives <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.</p> Methods <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).</p> Results <p>The final cohort included 513 FSAs, 12,911,594 residents—127,123 (0.98%) who received and 12,784,471 (99.02%) who did not receive nirmatrelvir-ritonavir. There was an 18-fold variation across FSAs, 133–2417 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<sub>adj</sub>) = 0.98 (95% CI 0.97, 1.00, <i>p</i> = 0.014)) and less post-secondary education (RR<sub>adj</sub> = 0.98 (95% CI 0.97, 1.00, <i>p</i> = 0.044)). Other sociodemographic variables did not have significantly lower nirmatrelvir-ritonavir use.</p> Conclusion <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.</p>

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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

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年4月13日

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  • Meagan Lacroix,
  • Bradley J. Langford,
  • Cynthia Chen,
  • Jun Wang,
  • Mina Tadrous,
  • Nick Daneman,
  • Valerie Leung,
  • Tara Gomes,
  • Lindsay Friedman,
  • Peter Daley,
  • Kevin A. Brown,
  • Kevin L. Schwartz

摘要

Objectives

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.

Methods

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).

Results

The final cohort included 513 FSAs, 12,911,594 residents—127,123 (0.98%) who received and 12,784,471 (99.02%) who did not receive nirmatrelvir-ritonavir. There was an 18-fold variation across FSAs, 133–2417 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 (RRadj) = 0.98 (95% CI 0.97, 1.00, p = 0.014)) and less post-secondary education (RRadj = 0.98 (95% CI 0.97, 1.00, p = 0.044)). Other sociodemographic variables did not have significantly lower nirmatrelvir-ritonavir use.

Conclusion

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.