Socioeconomic inequality in compliance with precautions and health behavior changes during the COVID-19 outbreak: an analysis of the Korean Community Health Survey 2020

Abstract

Objectives: This study examined socioeconomic inequalities in compliance with precautions and health behavior changes during the coronavirus disease 2019 (COVID-19) outbreak using a representative Korean sample.

Methods: This exploratory study utilized around 210,000 participants aged ≥25 years in the Korean Community Health Survey 2020. Socioeconomic status was measured with educational attainment and household income. Outcomes included non-compliance with 8 precaution measures and deterioration in 6 health behaviors. The relative inequality index (RII) was calculated to quantify the degree of inequality by education and income level. RII values >1.0 indicate that deprived people have a higher frequency of health problems, and RII values <1.0 conversely indicate a higher frequency of health problems in more advantaged groups.

Results: People with lower education or income levels tended to have higher rates of non-compliance with COVID-19 safety precautions (RII range, 1.20 to 3.05). Lower education and income levels were associated with an increased smoking amount (RII=2.10 and 1.67, respectively) and sleep duration changes (RII=1.21 and 1.36, respectively). On the contrary, higher education and income levels were associated with decreased physical activity (RII=0.59 and 0.77, respectively) and increased delivery food consumption (RII=0.27 and 0.37, respectively). However, increased alcohol drinking was associated with lower education and income levels in younger men (RII=1.73 and 1.31, respectively), but with higher levels in younger women (RII=0.73 and 0.68, respectively).

Conclusions: Our findings suggest the need to develop customized strategies, considering the characteristics of the target population, to decrease the burden and impact of the COVID-19 outbreak.

Keywords: Coronavirus; Educational status; Health behavior; Income; Public health.

Figure 1.

Relative index of inequality (RII) by education levels for failure to comply with coronavirus disease 2019 (COVID-19) safety precautions and health behavior deterioration in the total population and by gender and age. Questions were sorted by descending order of RII values in the total population analysis. ¹Adjusted for quarantine isolation experience due to COVID-19 infection and recent experience of fever/coughing. ²Adjusted for smoking status (current/past). ³Adjusted for sleep duration. ⁴Adjusted for alcohol drinking frequencies. ⁵Adjusted for moderate physical activity (yes/no).

Figure 2.

Relative index of inequality (RII) by income levels for failure to comply with coronavirus disease 2019 (COVID-19) safety precautions and health behavior deterioration in the total population and by gender and age. Questions were sorted by descending order of RII values in the total population analysis. ¹Adjusted for quarantine isolation experience due to COVID-19 infection and recent experience of fever/coughing. ²Adjusted for smoking status (current/past). ³Adjusted for sleep duration. ⁴Adjusted for alcohol drinking frequencies. ⁵Adjusted for moderate physical activity (yes/no).