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Jech-2020-214475.Full.Pdf J Epidemiol Community Health: first published as 10.1136/jech-2020-214475 on 5 June 2020. Downloaded from Original research Are we all in this together? Longitudinal assessment of cumulative adversities by socioeconomic position in the first 3 weeks of lockdown in the UK Liam Wright ,1 Andrew Steptoe,2 Daisy Fancourt 2 ► Additional material is ABSTRACT miscommunication, and not being able to afford to – published online only. To view Background Despite media claims that coronavirus lose income from missing work.1 4 Nevertheless, please visit the journal online disease 2019 (COVID-19) is uniting societies and (http://dx.doi.org/10.1136/ there has also been concern that the virus could jech-2020-214475). countries in shared experience, there has been concern expose and widen existing inequalities within – that the pandemic is in fact exposing and widening societies.257 This is particularly problematic as it 1Department of Epidemiology existing inequalities within societies. Data have shown could trigger a vicious cycle of increasing inequal- and Public Health, University these differences for cases and fatalities, but data on ities that weaken economic structures within socie- College London, London, UK 2 other types of adversities are lacking. Therefore, this study ties and also exacerbate the spread of the virus, Department of Behavioural explored the changing patterns of adversity relating to the Science and Health, University leading to the labelling of COVID-19 as College London, London, UK COVID-19 pandemic by socioeconomic position (SEP) a ‘pandemic of inequality’.457 during the early weeks of lockdown in the UK. Studies from previous epidemics such as severe Correspondence to Methods Data were from 12 527 UK adults in the acute respiratory syndrom (SARS), Middle East University College London COVID-19 Social Study (a panel Dr Daisy Fancourt, respiratory syndrome (MERS) and Ebola have sug- Department of Behavioural study that involves online weekly data collection from gested that people can experience a range of adver- Science and Health, University participants during the COVID-19 pandemic). We 8 College London Research analysed data collected from 25 March to 14 April 2020. sities during and in the aftermath of epidemics. Department of Epidemiology The sample was well-stratified and weighted to These can include adversities related to the virus and Public Health, London population proportions of gender, age, ethnicity, itself (such as infection or bereavement), as well as WC1E 7HB, UK; challenges meeting basic needs (such as access to [email protected] education and country of living. We used Poisson and 9–11 logit models to assess 10 different types of adverse food, medication and accommodation), and Received 1 May 2020 experiences depending on an index of SEP over time. the experience of financial loss (including loss of 11–16 Revised 11 May 2020 Results There was a clear gradient across the employment and income). The wider health Accepted 15 May 2020 number of adverse events experienced each week by literature suggests that people from lower socio- SEP. This was most clearly seen for adversities relating economic backgrounds are less resilient to shocks to finances (including loss of employment and cut in such as ill-health, experiencing greater financial income) and basic needs (including access to food and burden, and hardship.17 This suggests there is medications) but less for experiences directly relating likely to be a social gradient in these experiences to the virus. Inequalities were maintained with no during COVID-19, but so far there has been limited reductions in discrepancies between socioeconomic empirical investigation of inequalities in experi- http://jech.bmj.com/ groups over time. ence of adversity during the pandemic. Conclusions There were clear inequalities in adverse Nevertheless, these experiences of burden and experiences during the COVID-19 pandemic in the early hardship are vital to understand as studies of pre- weeks of lockdown in the UK. Results suggest that vious epidemics have found a relationship between measures taken to try to reduce such adverse events did experience of adversity and psychological conse- not go far enough in tackling inequality. quences including post-traumatic stress and depression.16 This echoes wider literature on the on September 30, 2021 by guest. Protected copyright. strong relationship between adversities relating to finances, basic needs, and ill-health, and poor men- – INTRODUCTION tal and physical health outcomes.18 21 Over the past few weeks, there have been claims in Therefore, this study explored the changing pat- the media that coronavirus disease 2019 (COVID- terns of adversity relating to the COVID-19 pandemic 19) is uniting societies and countries in shared by socioeconomic position (SEP) during the first few experience: ‘we are all in this together’. However, weeks of lockdown in the UK. We focused on three scientific papers are beginning to emerge arguing types of adversity: (1) financial stressors (loss of work, ©Author(s)(ortheir that COVID-19 is disproportionately affecting vul- partner’s loss of work, cut in household income or employer(s)) 2020. Re-use inability to pay bills), (2) challenges relating to basic permitted under CC BY. nerable populations. Much of this research has Published by BMJ. focused on inequalities in cases and fatalities, citing needs (including food, medications and accommoda- challenges for more disadvantaged groups due to tion)and(3)experienceofthevirusitself(including To cite: Wright L, Steptoe individuals facing difficulties in accessing healthcare contracting the virus, a close person being hospitalised A, Fancourt D. J Epidemiol in certain countries, being less able to adhere to and a close person dying). We sought to explore the Community Health Epub ahead of print: [please protective social distancing measures due to living nature of the relationship between SEP and (1) num- include Day Month Year]. in more overcrowded areas, having a higher burden ber of adversities experienced, (2) type of adversity doi: 10.1136/ of pre-existing diseases and risk factors, being dis- experienced, and (3) how the relationship evolved jech-2020-214475 proportionally affected by misinformation and over the first 3 weeks of lockdown. Wright L, et al. J Epidemiol Community Health 2020;0:1–6. doi:10.1136/jech-2020-214475 1 J Epidemiol Community Health: first published as 10.1136/jech-2020-214475 on 5 June 2020. Downloaded from Original research METHODS or lower (qualifications at age 16), A-Levels or vocational training Participants (qualifications at age 18), undergraduate degree, postgraduate Data were drawn from the University College London (UCL) degree), (3) employment status (employed, inactive and unem- COVID-19 Social Study—a large panel study of the psychological ployed), (4) housing tenure (own outright, own with mortgage, and social experiences of over 70 000 adults (aged 18+) in the UK rent/live rent-free) and (5) household overcrowding (binary: >1 during the COVID-19 pandemic. The study commenced on person per room). From these variables, we constructed a Low 21 March 2020, with recruitment ongoing. The study involves SEP index measure by counting indications of low SEP (income online weekly data collection from participants during the <£16 000, educational qualifications of GCSE or lower, unem- COVID-19 pandemic in the UK. While not random, the study has ployed, living in rented or rent-free accommodation, and living in a well-stratified sample that was recruited using three primary overcrowded accommodation), collapsing into 0, 1 and 2+ indica- approaches. First, snowballing was used, including promoting the tions of low SEP to attain adequate sample sizes for each category. study through existing networks and mailing lists (including large databases of adults who had previously consented to be involved in Covariates health research across the UK), print and digital media coverage, and To account for broad demographic differences that could con- social media. Second, more targeted recruitment was undertaken found the association between SEP and adversity experiences, we focusing on (1) individuals from a low-income background, (2) also included variables for gender (male, female), age (18–24, individuals with no or few educational qualifications, and (3) indi- 25–34, 35–49, 50–64, 65+), marital status (cohabiting with viduals who were unemployed. Third, the study was promoted via partner, living away from partner, single, divorced/widowed) partnerships with third sector organisations to vulnerable groups, and ethnicity (white, non-white). including adults with pre-existing mental illness, older adults and carers. The study was approved by the UCL Research Ethics Analysis Committee (12467/005) and all participants gave informed consent. We assessed experienced adversities according to SEP by estimat- Questionnaire items related to newly experienced adversities ing Poisson models for each of the 3 weeks separately. First, we were available from 25 March 2020— 1 day after legal enforce- extracted the predicted number of adversities according to SEP ment of lockdown commenced. We used data from the 3 weeks using average marginal effects and plotted the estimates to test following this date (25 March–14 April 2020), limiting our ana- whether social gradients were present and whether they changed lysis to a balanced panel of participants who were interviewed in in size by week. Second, we repeated this exercise for each all of these weeks (n=14 309; 58.7% of individuals interviewed adversity separately by estimating logit models for each adversity between 25 and 31 March 2020). We excluded participants with and each week of data. Analyses were adjusted for age, gender, missing data on any variable used in this study (n=1782; 12.45% ethnicity and marital status. Third, we compared estimated dif- of balanced panel; 3.21% missing weights, 9.67% missing SEP ferences in the prevalence of adversities between highest and measures and 0.01% missing outcome measure). This provided lowest SEP groups in weeks 1 and 3 to explore if there was any a final analytical sample of 12 527 participants.
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