@misc{discovery10117384,
            note = {This version is the version of record. For information on re-use, please refer to the publisher's terms and conditions.},
       publisher = {MedRxiv},
            year = {2020},
           title = {Inequality in access to health and care services during lockdown - Findings from the COVID-19 survey in five UK national longitudinal studies},
           month = {September},
         address = {Cold Spring Harbor, NY, USA},
        abstract = {Background: Access to health services and adequate care is influenced by sex, ethnicity, socio-economic position (SEP) and burden of co-morbidities. However, it is unknown whether the COVID-19 pandemic further deepened these already existing health inequalities. /

Methods: Participants were from five longitudinal age-homogenous British cohorts (born in 2001, 1990, 1970, 1958 and 1946). A web and telephone-based survey provided data on cancelled surgical or medical appointments, and the number of care hours received during the 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, keyworker status, and whether participants had received a shielding letter. Meta-analyses were performed across the cohorts and meta-regression evaluated the effect of age as a moderator. /

Findings: 14891 participants were included. 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{\ensuremath{<}}0.0001). Ethnic minorities and those with a chronic illness required a higher number of care hours during the lockdown (both OR {$\approx$}2.00, all p{\ensuremath{<}}0.002). Age was not independently associated with either outcome in meta-regression. SEP was not associated with cancellation or care hours. /

Interpretation: The UK government's lockdown approach during the COVID-19 pandemic appears to have deepened existing health inequalities, impacting predominantly females, 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 second wave.},
          author = {Topriceanu, C-C and Wong, A and Moon, J and Hughes, A and Bann, D and Chaturvedi, N and Patalay, P and Conti, G and Captur, G},
             url = {https://doi.org/10.1101/2020.09.12.20191973}
}