An investigation of factors affecting changes in health behaviours during the COVID-19 pandemic in a UK population-based cohort study
Public Health 2022
PubMed ID : 36209533
PMCID : PMC9444493
The COVID-19 pandemic has led to changes in behaviours which may have different health effects in population sub-groups. We investigated whether within-individual changes in health behaviours from before to during the pandemic differ by socio-economic deprivation, age, or sex.
Prospective cohort study.
Participants were recruited from the existing UK Fenland cohort study with measurements of health behaviours twice pre-pandemic (2005- February 2020) and three times during the pandemic (July 2020-April 2021). Health behaviours included daily servings of fruit and vegetables, units of alcohol consumed per week, smoking status, sleep, total and domain-specific physical activity energy expenditure. Socio-demographic information (English indices of multiple deprivation (IMD), education, occupation and ethnicity), and COVID-19 antibody status were also collected. Participants were grouped into three categories based on their IMD score: most, middle and least deprived.
Participants were included if they had completed at least one measurement during the pandemic and one pre-pandemic (n=3212). Fruit and vegetable consumption, total physical activity energy expenditure and smoking prevalence decreased during the pandemic compared to pre-pandemic whereas average sleep duration increased and alcohol consumption did not change. Decreases in fruit and vegetable intake and physical activity energy expenditure were most pronounced in the most deprived group compared to the least deprived group and were greater in women than men.
Socio-economic inequalities in health behaviours have worsened during the pandemic. As the country emerges from the COVID-19 pandemic, strategies to reduce health inequalities need to be put at the forefront of recovery plans.
This analysis finds that diet quality and physical activity levels fell substantially during the pandemic compared to pre-pandemic levels, and that the fall was greatest in those living in less affluent areas in Cambridgeshire. If these behaviour changes persist, this could have a considerable impact on widening inequalities, with those in the poorest areas more vulnerable to worse longer-term health as a result.
The COVID-19 pandemic exposed clear inequalities in the UK, with people with existing health conditions and living in the poorest areas of the country more likely to die from COVID-19 than the wealthiest. Furthermore, the pandemic and related restrictions also had an impact on everyday life including how active people were, their diets, alcohol consumption, sleep and smoking.
Using data from the Fenland Study and the Fenland COVID-19 study, researchers were able to compare measures of these behaviours taken on two occasions in the years before the pandemic (2005-2020) with the same measures taken during the pandemic on three occasions (2020-2021). The research team found that, in particular, levels of physical activity and fruit and vegetable consumption decreased during the pandemic period. This decrease was much larger among participants living in poorer areas of Cambridgeshire compared to those living in more affluent areas and also higher in women compared to men. Differences by age were also noticeable with those over 60 years old having greater decreases in home, leisure and work based physical activity compared to younger age groups.
This analysis shows that the pandemic has widened inequalities in health behaviours, and supports the need for strategies to improve diet and physical activity equitably in the UK population.