Socio-demographic inequalities in COVID-19 health care access and experiences in the United Kingdom: intersectional and mixed-methods analyses of open and closed questions in a prospective cohort study
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Introduction
Inequalities in health care access and experiences during the COVID-19 pandemic have been observed along axes of social advantage. It is less well understood how access to care varied intersectionally with combinations of multiple social factors, and how social advantage shaped care experiences for COVID-19 illness.
Methods
We analysed responses to both closed (N = 3,516) and open (N = 335) survey questions relating to health and social care access and experiences during the first two and a half years of the COVID-19 pandemic in the United Kingdom community-based cohort, COVID Symptom Study Biobank. Causal effects of individual socio-demographic variables on access to health and social care were estimated with multivariable regression models, weighted for inverse probability of survey completion and adjusted for potential confounders. Associations between care access issues and social strata comprising combinations of sex, education level and local area deprivation were estimated using the intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) approach. Responses to open questions on health care experiences for COVID-19 illness were deductively coded and quantitatively analysed to estimate associations between socio-demographic advantage and various aspects of care experiences.
Results
Gradients in health and social care access along the lines of social advantage were observed in intersectional MAIHDA models, with the predicted probability of access issues highest for the stratum comprising female participants with lowest education and highest deprivation levels (42.9%, 95% CI: 31.9%-54.6%), and lowest for male participants with highest education and lowest deprivation (18.7%, 95% CI: 12.8%-26.7%). Socially disadvantaged participants also reported receiving poorer care for COVID-19, with lower likelihood of reporting receiving adequate care and specialist care for long COVID, and higher likelihood of negative experiences of care vs. advantaged participants.
Conclusions
Inequalities in likelihood of health and social care access issues were observed, as well as inequalities in care experiences specifically for COVID-19, with issues accessing care and poorer experiences more likely to be reported by individuals with greater social disadvantage.
Funding
Chronic Disease Research Foundation, National Institute for Health and Care Research, Medical Research Council, Zoe Ltd.
Key terms
Patient experience; Health care access; Quality of care; Long COVID; Mixed methods; Intersectionality
Patient or Public Contribution
Members of the COVID Symptom Study Biobank Volunteer Advisory Panel provided feedback on the questionnaire that was our primary data source for this analysis. Previous discussions with the Volunteer Advisory Panel informed the aims and objectives of this study.
Plain language summary
Problems getting care for health issues has been common in the COVID-19 pandemic. Problems have also been more common for certain groups, such as women, people from ethnic minorities, and people in lower paid jobs. But there hasn’t been much research that has looked at how problems getting care has varied between people with different combinations of characteristics. Research also hasn’t looked very much at whether people with different circumstances had different experiences of getting care for COVID-19. In this study, we looked at responses to a questionnaire from August 2022 from a health study focused on understanding the long term effects of COVID-19. We found that our female participants tended to be more likely to experience problems accessing health and social care services. We also found that participants with disadvantaged circumstances, such as having a low education level, living in a deprived area, and having low income, were more likely to have problems accessing care. Similarly, participants with more disadvantaged circumstances had negative experiences of getting health care for COVID-19 more often than more advantaged participants. These results suggest that health care access and experiences vary significantly depending on people’s circumstances. This differences in experiences need to be addressed, particularly for people living with symptoms of long COVID.
