Deprivation and exposure to public activities during the COVID-19 pandemic in England and Wales

Abstract

Background: Differential exposure to public activities may contribute to stark deprivation-related inequalities in SARS-CoV-2 infection and outcomes but has not been directly investigated. We set out to investigate whether participants in Virus Watch-a large community cohort study based in England and Wales-reported differential exposure to public activities and non-household contacts during the autumn-winter phase of the COVID-19 pandemic according to postcode-level socioeconomic deprivation.

Methods: Participants (n=20 120-25 228 across surveys) reported their daily activities during 3 weekly periods in late November 2020, late December 2020 and mid-February 2021. Deprivation was quantified based on participants' residential postcode using English or Welsh Index of Multiple Deprivation quintiles. We used Poisson mixed-effect models with robust standard errors to estimate the relationship between deprivation and risk of exposure to public activities during each survey period.

Results: Relative to participants in the least deprived areas, participants in the most deprived areas exhibited elevated risk of exposure to vehicle sharing (adjusted risk ratio (aRR) range across time points: 1.73-8.52), public transport (aRR: 3.13-5.73), work or education outside of the household (aRR: 1.09-1.21), essential shops (aRR: 1.09-1.13) and non-household contacts (aRR: 1.15-1.19) across multiple survey periods.

Conclusion: Differential exposure to essential public activities-such as attending workplaces and visiting essential shops-is likely to contribute to inequalities in infection risk and outcomes. Public health interventions to reduce exposure during essential activities and financial and practical support to enable low-paid workers to stay at home during periods of intense transmission may reduce COVID-related inequalities.

Keywords: COVID-19; deprivation; inequalities.

Figure 1

Risk ratios for public activities and non-household contacts by IMD quintile (24 November 2020–1 December 2020). Note: all models adjusted for participant age, sex and region of residence. Q <0.05 indicates that the Benjamini-Hochberg corrected p value (q value), which corrects for multiple comparisons, falls below <0.05. RR, risk ratio. IMD, Index of Multiple Deprivation.

Figure 2

Risk ratios for public activities and non-household contacts by IMD quintile (23 December 2020–27 December 2020). Note: all models adjusted for participant age, sex and region of residence. Q <0.05 indicates that the Benjamini-Hochberg corrected p value (q value), which corrects for multiple comparisons, falls below <0.05. RR, risk ratio. IMD, Index of Multiple Deprivation.

Figure 3

Risk ratios for public activities and non-household contacts by IMD quintile (09 February 21–16 Febrry 21). Note: all models adjusted for participant age, sex and region of residence. Q <0.05 indicates that the Benjamini-Hochberg corrected p value (q value), which corrects for multiple comparisons, falls below <0.05. RR, risk ratio. IMD, Index of Multiple Deprivation.