Inequalities in healthcare disruptions during the COVID-19 pandemic: evidence from 12 UK population-based longitudinal studies

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Abstract

OBJECTIVES: We investigated associations between multiple sociodemographic characteristics (sex, age, occupational social class, education and ethnicity) and self-reported healthcare disruptions during the early stages of the COVID-19 pandemic.

DESIGN: Coordinated analysis of prospective population surveys.

SETTING: Community-dwelling participants in the UK between April 2020 and January 2021.

PARTICIPANTS: Over 68 000 participants from 12 longitudinal studies.

OUTCOMES: Self-reported healthcare disruption to medication access, procedures and appointments.

RESULTS: Prevalence of healthcare disruption varied substantially across studies: between 6% and 32% reported any disruption, with 1%-10% experiencing disruptions in medication, 1%-17% experiencing disruption in procedures and 4%-28% experiencing disruption in clinical appointments. Females (OR 1.27; 95% CI 1.15 to 1.40; I 2=54%), older persons (eg, OR 1.39; 95% CI 1.13 to 1.72; I 2=77% for 65-75 years vs 45-54 years) and ethnic minorities (excluding white minorities) (OR 1.19; 95% CI 1.05 to 1.35; I 2=0% vs white) were more likely to report healthcare disruptions. Those in a more disadvantaged social class were also more likely to report healthcare disruptions (eg, OR 1.17; 95% CI 1.08 to 1.27; I 2=0% for manual/routine vs managerial/professional), but no clear differences were observed by education. We did not find evidence that these associations differed by shielding status.

CONCLUSIONS: Healthcare disruptions during the COVID-19 pandemic could contribute to the maintenance or widening of existing health inequalities.

Original languageEnglish
Article numbere064981
JournalBMJ Open
Volume12
Issue number10
Early online date13 Oct 2022
DOIs
Publication statusPublished online - 13 Oct 2022

Bibliographical note

Funding Information:
This work was supported by the National Core Studies, an initiative funded by UKRI, NIHR and the Health and Safety Executive. The COVID-19 Longitudinal Health and Well-being National Core Study was funded by the Medical Research Council (MC_PC_20030). Understanding Society is an initiative funded by the Economic and Social Research Council and various government departments, with scientific leadership by the Institute for Social and Economic Research, University of Essex, and survey delivery by NatCen Social Research and Kantar Public. The Understanding Society COVID-19 Study is funded by the Economic and Social Research Council (ES/K005146/1) and the Health Foundation (2076161). The research data are distributed by the UK Data Service. The Millennium Cohort Study, Next Steps, the 1970 British Cohort Study and 1958 National Child Development Study are supported by the Centre for Longitudinal Studies, Resource Centre 2015-20 grant (ES/M001660/1) and a host of other cofunders. The 1946 NSHD cohort is hosted by the MRC Unit for Lifelong Health and Ageing funded by the Medical Research Council (MC_UU_00019/1 Theme 1: Cohorts and Data Collection). The COVID-19 data collections in these five cohorts were funded by the UKRI grant: Understanding the economic, social and health impacts of COVID-19 using lifetime data: evidence from 5 nationally representative UK cohorts (ES/V012789/1). The English Longitudinal Study of Ageing was developed by a team of researchers based at University College London, NatCen Social Research, the Institute for Fiscal Studies, the University of Manchester and the University of East Anglia. The data were collected by NatCen Social Research. The funding is currently provided by the National Institute on Aging (Ref: R01AG017644) and by a consortium of UK government departments: Department for Health and Social Care; Department for Transport; Department for Work and Pensions, which is coordinated by the National Institute for Health Research (NIHR, Ref: 198-1074). Funding has also been provided by the Economic and Social Research Council (ESRC).The UK Medical Research Council and Wellcome Trust (grant reference: 217065/Z/19/Z) and the University of Bristol provide core support for ALSPAC. A comprehensive list of grants funding is available on the ALSPAC website ( http://www.bristol.ac.uk/alspac/external/documents/grant-acknowledgements.pdf ). TwinsUK receives funding from the Wellcome Trust (WT212904/Z/18/Z), the National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust and King's College London. TwinsUK is also supported by the Chronic Disease Research Foundation and Zoe Global. Generation Scotland received core support from the Chief Scientist Office of the Scottish Government Health Directorates (CZD/16/6) and the Scottish Funding Council (HR03006). Genotyping of the GS:SFHS samples was carried out by the Genetics Core Laboratory at the Wellcome Trust Clinical Research Facility, Edinburgh, Scotland, and was funded by the Medical Research Council UK and the Wellcome Trust (Wellcome Trust Strategic Award 'STratifying Resilience and Depression Longitudinally' (STRADL); reference: 104036/Z/14/Z). Generation Scotland is funded by the Wellcome Trust (216767/Z/19/Z). Born in Bradford (BIB) receives core infrastructure funding from the Wellcome Trust (WT101597MA), and a joint grant from the UK Medical Research Council (MRC) and UK Economic and Social Science Research Council (ESRC) (MR/N024397/1), and one from the British Heart Foundation (BHF) (CS/16/4/32482). The National Institute for Health Research Yorkshire and Humber ARC and the Clinical Research Network both provide support for BIB research. SVK acknowledges funding from an NRS Senior Clinical Fellowship (SCAF/15/02), the Medical Research Council (MC_UU_00022/2) and the Scottish Government Chief Scientist Office (SPHSU17). ASFK acknowledges funding from the ESRC (ES/V011650/1). EJT acknowledges funding from Wellcome Trust (WT212904/Z/18/Z). GBP acknowledges funding from the Economic and Social Research Council (ES/V012789/1). GC acknowledges funding from British Heart Foundation Special Programme Grant SP/20/2/34841

Publisher Copyright:
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.

Keywords

  • Aged
  • Aged, 80 and over
  • COVID-19/epidemiology
  • Female
  • Health Services Accessibility
  • Humans
  • Longitudinal Studies
  • Pandemics
  • Prospective Studies
  • United Kingdom/epidemiology
  • PUBLIC HEALTH
  • SOCIAL MEDICINE
  • COVID-19
  • EPIDEMIOLOGY

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