Objective Access to health services and adequate care is influenced by sex, ethnicity, socioeconomic position (SEP) and the burden of comorbidities. Our study aimed to assess whether the COVID-19 pandemic further deepened these already existing health inequalities.
Design Cross-sectional study.
Setting Data were collected from five longitudinal age-homogenous British cohorts (born in 2000-2002, 1989-1990, 1970, 1958 and 1946).
Participants A web survey was sent to the cohorts. Anybody who responded to the survey was included, resulting in 14 891 eligible participants.
Main outcomes measured The survey provided data on cancelled surgical or medical appointments, and the number of care hours received in a week during the first UK COVID-19 national lockdown.
Interventions Using binary or ordered logistic regression, we evaluated whether these outcomes differed by sex, ethnicity, SEP and having a chronic illness. Adjustment was made for study design, non-response weights, psychological distress, presence of children or adolescents in the household, COVID-19 infection, key worker status, and whether participants had received a shielding letter. Meta-analyses were performed across the cohorts, and meta-regression was used to evaluate the effect of age as a moderator.
Results Women (OR 1.40, 95% CI 1.27 to 1.55) and those with a chronic illness (OR 1.84, 95% CI 1.65 to 2.05) experienced significantly more cancellations during lockdown (all p<0.0001). Ethnic minorities and those with a chronic illness required a higher number of care hours during the lockdown (both OR≈2.00, all p<0.002). SEP was not associated with cancellation or care hours. Age was not independently associated with either outcome in the meta-regression.
Conclusion The UK government’s lockdown approach during the COVID-19 pandemic appears to have deepened existing health inequalities, impacting predominantly women, ethnic minorities and those with chronic illnesses. Public health authorities need to implement urgent policies to ensure equitable access to health and care for all in preparation for a fourthwave.
- quality in health care
- public health
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Contributors CCT analysed the data and wrote the manuscript. CCT, JCM, ADH, DB, NC, PP, GCo and GCa were involved in the study design and implementation. AW, ADH, DB, NC, PP and GCo actively participated in the data acquisition. GCa contributed to the data analysis, interpretation of the results and manuscript drafting; was the guarantor of this work; and attested that all listed authors met the authorship criteria and that no others meeting the criteria were omitted. All authors were involved in critically revising the manuscript and approving the final version.
Funding The study was funded by the Economic and Social Research Council under the Center for Longitudinal Studies, Resource Center 2015–2020 (grant number ES/M001660/1) and by the Medical Research Council (grant MC_UU_00019/1). GCa is supported by British Heart Foundation (MyoFit46 Special Programme Grant SP/20/2/34841), the National Institute for Health Research Rare Diseases Translational Research Collaboration (NIHR RD-TRC) and by the NIHR UCL Hospitals Biomedical Research Center. JCM is directly and indirectly supported by the UCL Hospitals NIHR BRC and Biomedical Research Unit at Barts Hospital, respectively. DB is supported by the Economic and Social Research Council (grant number ES/M001660/1) and by The Academy of Medical Sciences/Wellcome Trust (Springboard Health of the Public in 2040 award: HOP001/1025). AH receives support from the British Heart Foundation, the Economic and Social Research Council, the Horizon 2020 Framework Programme of the European Union, the National Institute on Aging, the National Institute for Health Research University College London Hospitals Biomedical Research Center, and the UK Medical Research Council and works in a unit that receives support from the UK Medical Research Council. GCo thanks for support the European Research Council under the European Union’s Horizon 2020 research and innovation programme (grant agreement number 819752 DEVORHBIOSHIP–ERC-2018-COG).
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval Ethical approval was obtained from relevant committees and from the University College London/Institute of Education research ethics committee (REC1334). All participants gave informed consent before taking part in the study.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request. NSHD data are available online (https://www.nshd.mrc.ac.uk/data). Data from the remaining cohorts are available from the UK Data Archive (https://www.data-archive.ac.uk).
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