Evaluating access to health and care services during lockdown by the COVID-19 survey in five UK national longitudinal studies
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Abstract
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.
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SciScore for 10.1101/2020.09.12.20191973: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable Exposures: Sex was recoded as 0 = male and 1 = female, while ethnicity was recoded as 0 = non-White and 1 = White. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:A limitation of the study is data missingness due to low response rates, particularly in younger cohorts, and the small sample …
SciScore for 10.1101/2020.09.12.20191973: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable Exposures: Sex was recoded as 0 = male and 1 = female, while ethnicity was recoded as 0 = non-White and 1 = White. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:A limitation of the study is data missingness due to low response rates, particularly in younger cohorts, and the small sample size of the older cohorts, particularly in NSHD. However, given the longitudinal nature of the cohorts, all the analyses have been adjusted for via sample weights derived from missingness predictors14,15 that would not otherwise be possible for cross-sectional studies. Secondly, we have binarized the ethnicity variable to enable sufficient sample sizes for comparisons which precludes investigation of differences between the diverse ethnic groups which exist in the UK. As the older cohorts (NSHD, NCDS and BCS70) consist of only white participants, we are unable to describe findings for older persons belonging to minority ethnic groups. These individuals may have been most adversely affected by the national lockdown. As self-reported measures were used, the number of care hours needed before and during the lockdown were subject to reporting biases. In addition, single categorical outcome variables do not have the capacity to measure the impact spectrum generated by the cancelled appointments as well as the loss of care hours. Due to study design, the number of care hours were recorded for self or other household member. Moreover, we were unable to separate effects generated by the pandemic from recognized confounders such as seasonal variation in the number of care hours needed, as well as unobserved confounders. The overall prevalence of outcomes diffe...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
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SciScore for 10.1101/2020.09.12.20191973: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable Females (OR 1·40, 95% confidence interval [1·27,1·55]) and those with a chronic illness (OR 1·84 [1·65-2·05]) experienced significantly more cancellations during lockdown (all p<0·0001). Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
A limitation of the study is data missingness due …
SciScore for 10.1101/2020.09.12.20191973: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable Females (OR 1·40, 95% confidence interval [1·27,1·55]) and those with a chronic illness (OR 1·84 [1·65-2·05]) experienced significantly more cancellations during lockdown (all p<0·0001). Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
A limitation of the study is data missingness due to low response rates, particularly in younger cohorts, and the small sample size of the older cohorts, particularly in NSHD. However, given the longitudinal nature of the cohorts, all the analyses have been adjusted for via sample weights derived from missingness predictors14,15 that would not otherwise be possible for cross-sectional studies. Secondly, we have binarized the ethnicity variable to enable sufficient sample sizes for comparisons which precludes investigation of differences between the diverse ethnic groups which exist in the UK. As the older cohorts (NSHD, NCDS and BCS70) consist of only white participants, we are unable to describe findings for older persons belonging to minority ethnic groups. These individuals may have been most adversely affected by the national lockdown. As selfreported measures were used, the number of care hours needed before and during the lockdown were subject to reporting biases. In addition, single categorical outcome variables do not have the capacity to measure the impact spectrum generated by the cancelled appointments as well as the loss of care hours. Due to study design, the number of care hours were recorded for self or other household member. Moreover, we were unable to separate effects generated by the pandemic from recognized confounders such as seasonal variation in the number of care hours needed, as well as unobserved confounders. The overall prevalence of outcomes differ...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We found bar graphs of continuous data. We recommend replacing bar graphs with more informative graphics, as many different datasets can lead to the same bar graph. The actual data may suggest different conclusions from the summary statistics. For more information, please see Weissgerber et al (2015).
Results from JetFighter: We did not find any issues relating to colormaps.
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