Changes in the behavioural determinants of health during the coronavirus (COVID-19) pandemic: gender, socioeconomic and ethnic inequalities in 5 British cohort studies

Abstract

Background: The coronavirus (COVID-19) pandemic and consequent physical distancing measures are expected to have far-reaching consequences on population health, particularly in already disadvantaged groups. These consequences include changes in health impacting behaviours (such as exercise, sleep, diet and alcohol use) which are arguably important drivers of health inequalities. We sought to add to the rapidly developing empirical evidence base investigating the impacts of the pandemic on such behavioural outcomes. Methods: Using data from five nationally representative British cohort studies (born 2001, 1990, 1970, 1958, and 1946), we investigated sleep, physical activity (exercise), diet, and alcohol intake (N=14,297). Using measures of each behaviour reported before and during lockdown, we investigated change in each behaviour, and whether such changes differed by age/cohort, gender, ethnicity, and socioeconomic position (SEP; childhood social class, education attainment, and adult reporting of financial difficulties). Binary or ordered logistic regression models were used, adjusting for prior measures of each health behaviour and accounting for study design and non-response weights. Meta-analyses were used to pool cohort-specific estimates and formally test for heterogeneity across cohorts. Results: Changes in these outcomes occurred in in both directions ie, shifts from the middle part of the distribution to both declines and increases in sleep, exercise, and alcohol use. For all outcomes, older cohorts were less likely to report changes in behaviours compared with younger cohorts. In the youngest cohort (born 2001), the following shifts were more evident: increases in exercise, fruit and vegetable intake, sleep, and less frequent alcohol consumption. After adjustment for prior behaviour levels, during lockdown females were less likely to sleep within the typical range (6-9 hours) yet exercised more frequently; lower SEP was associated with lower odds of sleeping within the typical range (6-9 hours), lower exercise participation, and lower consumption of fruit and vegetables; and ethnic minorities were less likely than White participants to sleep within the typical range (6-9 hours), exercise less frequently, yet reported less frequent alcohol consumption. Conclusions: Our findings highlight the multiple changes to behavioural outcomes that may have occurred due to COVID-19 lockdown, and the differential impacts across generation, gender, SEP and ethnicity. Such changes require further monitoring given their possible implications to population health and the widening of health inequalities.

Different Responses to Stress, Health Practices, and Self-Care during COVID-19 Lockdown: A Stratified Analysis

“…Our findings are in line with several studies conducted in Spain, Austria, and UK, which have found that this situation seems to have a higher impact on women and young people, particularly stressful for those <35 years, people without work, and low income [ 4 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ].…”

“…Since the impact of COVID-19 pandemic and physical distancing measures on health behaviors drive important health inequalities, especially in those disadvantaged groups, further studies should monitor the differential impacts of the current pandemic across age, gender, socioeconomic disadvantage (in early and adult life) and culture/ethnicity and their possible implications to population health and the widening of health inequalities [ 16 ]. However, in order to reduce these health inequities and address immediate and long-term consequences, it is urgent to establish strategies for public health emergencies that take a gender-based approach into account [ 46 , 47 ].…”

“…However, stress responses, self-care or health behaviour changes during COVID-19 lockdown can differ by age, gender, ethnicity, and socioeconomic position. This situation seems particularly stressful for younger adults (<35 years), women, people without work and with low incomes [ 16 ]. Moreover ethnic minorities showed to undertake less exercise and consume lower amounts of fruit and vegetables during lockdown.…”

Have Lifestyle Habits and Psychological Well-Being Changed among Adolescents and Medical Students Due to COVID-19 Lockdown in Croatia?

“…The results of studies conducted so far on the physical activity and COVID-19 lockdown relationship are contradictory, showing either an increase of sedentariness [ 6 , 51 , 60 , 61 , 62 ], or a decrease [ 63 ]. Our results indicated that 41% of students surveyed in 2020 were active a few times a week, while additional 24% were active every day during lockdown.…”

Evaluating access to health and care services during lockdown by the COVID-19 survey in five UK national longitudinal studies

“…On 11 March 2020, the WHO declared the novel SARS-CoV-2 (also known as COVID- 19) outbreak a global pandemic. As the UK was facing a surge of new cases, the government imposed national lockdown restrictions on…”