Full information maximum likelihood estimation.

The COVID-19 pandemic has disproportionately affected different social and demographic groups, deepening the negative health implications of social and economic inequalities and highlighting the importance of social determinants of health. Despite a deep literature on pandemic-related disparities, specifically regarding social determinants and health outcomes, the influence of the accessibility of financial services on health outcomes during COVID-19 remains largely unexplored. Modeling (pre-omicron) COVID-19 mortality across 142 nations, we assess the impact of national-level usage and access to formal financial services. Two financial access indexes constructed through principal component analysis capture (1) usage of and access to formal financial tools and (2) reliance on alternative and informal financial tools. On average, nations with higher pre-pandemic use of and access to formal financial services had substantially lower population mortality risk from COVID-19, controlling for key population health, demographic, and socioeconomic covariates. The scale of effect is similar in magnitude—but opposite in direction—to major risk factors identified in previous literature, such as lung cancer, hypertension, and income inequality. Findings suggest that financial services deserve greater attention both in the public health literature related to COVID-19 and more broadly in policy discussions about fostering better public health overall.新冠疫情（COVID-19）对不同社会与人口群体的影响存在显著不均衡性，它加剧了社会经济不平等对健康的负面影响，同时凸显了健康社会决定因素（social determinants of health）的重要性。尽管已有大量围绕疫情相关健康差异的研究文献，尤其是聚焦于健康社会决定因素与健康结局的成果，但新冠疫情期间金融服务可及性对健康结局的影响仍未得到充分探索。本研究以142个国家的奥密克戎毒株流行前新冠死亡率为建模对象，评估国家级层面的正规金融服务使用与可及性所产生的影响。研究通过主成分分析（principal component analysis）构建了两项金融可及性指标：其一为正规金融工具的使用与可及性，其二为对替代性与非正规金融工具的依赖程度。在控制关键人口健康、人口统计学与社会经济协变量（covariates）的前提下，疫情前正规金融服务使用与可及性更高的国家，其人群新冠死亡率风险平均显著更低。该影响的效应量与既往研究中确认的主要危险因素（如肺癌、高血压与收入不平等）相当，但作用方向相反。研究结果表明，无论是在与新冠疫情相关的公共卫生研究领域，还是在旨在全面改善公共卫生的宏观政策讨论中，金融服务都应得到更多关注。