School of Medicine, University College London, London, UK.
UCL MRC Unit for Lifelong Health and Ageing, University College London, London, UK.
BMJ Open. 2021 Mar 18;11(3):e045813. doi: 10.1136/bmjopen-2020-045813.
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.
Cross-sectional study.
Data were collected from five longitudinal age-homogenous British cohorts (born in 2000-2002, 1989-1990, 1970, 1958 and 1946).
A web survey was sent to the cohorts. Anybody who responded to the survey was included, resulting in 14 891 eligible participants.
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.
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.
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.
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.
卫生服务的获取和充分的护理受到性别、种族、社会经济地位（SEP）和合并症负担的影响。我们的研究旨在评估 COVID-19 大流行是否进一步加深了这些已经存在的健康不平等。
横断面研究。
数据来自五个纵向年龄一致的英国队列（出生于 2000-2002 年、1989-1990 年、1970 年、1958 年和 1946 年）。
向队列发送了网络调查。任何对调查做出回应的人都被包括在内，共有 14891 名合格参与者。
调查提供了关于取消手术或医疗预约以及在英国第一次 COVID-19 全国封锁期间每周接受护理小时数的数据。
使用二项或有序逻辑回归，我们评估了这些结果是否因性别、种族、SEP 和患有慢性疾病而有所不同。调整了研究设计、无应答权重、心理困扰、家庭中是否有儿童或青少年、COVID-19 感染、关键工人身份以及参与者是否收到了屏蔽信。对队列进行了荟萃分析，并使用元回归评估了年龄作为调节因素的影响。
女性（OR 1.40，95%CI 1.27 至 1.55）和患有慢性疾病的人（OR 1.84，95%CI 1.65 至 2.05）在封锁期间经历了更多的取消（均 p<0.0001）。少数民族和患有慢性疾病的人在封锁期间需要更多的护理小时数（两者的 OR≈2.00，均 p<0.002）。SEP 与取消或护理小时数无关。年龄在元回归中与这两个结果均无关。
英国政府在 COVID-19 大流行期间的封锁措施似乎加深了现有的健康不平等，主要影响女性、少数民族和患有慢性疾病的人。公共卫生当局需要实施紧急政策，确保所有人都能公平地获得卫生和护理，为第四波疫情做好准备。
