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

Abstract

Background: Health systems worldwide have faced major disruptions due to COVID-19 which could exacerbate health inequalities. The UK National Health Service (NHS) provides free healthcare and prioritises equity of delivery, but the pandemic may be hindering the achievement of these goals. We investigated associations between multiple social characteristics (sex, age, occupational social class, education and ethnicity) and self-reported healthcare disruptions in over 65,000 participants across twelve UK longitudinal studies. Methods: Participants reported disruptions from March 2020 up to late January 2021. Associations between social characteristics and three types of self-reported healthcare disruption (medication access, procedures, appointments) and a composite of any of these were assessed in logistic regression models, adjusting for age, sex and ethnicity where relevant. Random-effects meta-analysis was conducted to obtain pooled estimates. Results: Prevalence of disruption varied across studies; between 6.4% (TwinsUK) and 31.8 % (Understanding Society) of study participants reported any disruption. Females (Odd Ratio (OR): 1.27 [95%CI: 1.15,1.40]; I2=53%), older persons (e.g. OR: 1.39 [1.13,1.72]; I2=77% for 65-75y vs 45-54y), and Ethnic minorities (excluding White minorities) (OR: 1.19 [1.05,1.35]; I2=0% vs White) were more likely to report healthcare disruptions. Those in a more disadvantaged social class (e.g. OR: 1.17 [1.08, 1.27]; I2=0% for manual/routine vs managerial/professional) were also more likely to report healthcare disruptions, but no clear differences were observed by education levels. Conclusion: The COVID-19 pandemic has led to unequal healthcare disruptions, which, if unaddressed, could contribute to the maintenance or widening of existing health inequalities.

Migrants’ primary care utilisation before and during the COVID-19 pandemic in England: An interrupted time series analysis

“…Substantial reductions in primary care consultations were observed across the UK during the first wave of the COVID-19 pandemic, 14 , 15 with people from minority ethnic groups reporting greater healthcare disruption than individuals from White ethnic groups. 16 However, the difference in primary care utilisation between migrants and non-migrants in England and how the pandemic has affected this, including the important interplay between migration and ethnicity within increasingly diverse communities, has not been studied. This is needed to help identify inequalities, and to inform service provision and policy.…”

CovidLife: a resource to understand mental health, well-being and behaviour during the COVID-19 pandemic in the UK

“…Higher pre-pandemic psychological distress was associated with increased odds of healthcare disruption, loss of employment and income, and reduced working hours or being furloughed, but it was not associated with housing disruption during the pandemic 38 . Another pre-print using data from over 65,000 individuals in 12 longitudinal studies, including CovidLife, found that healthcare disruption during COVID-19 was greater in female participants, older people, ethnic minorities, and those from more disadvantaged social classes 39 .…”

Changes in adolescents’ planned hospital care during the COVID-19 pandemic: analysis of linked administrative data

“… 1 2 However, young people have experienced considerable indirect effects of the pandemic through disruptions to health and other services, including much greater relative decreases in planned hospital admissions than adults. 3 Among adults, disruptions to healthcare during the pandemic have not been borne equally, 4 5 and it is likely that certain groups of young people have also been disproportionately affected.…”