When lockdown policies amplify social inequalities in COVID-19 infections: evidence from a cross-sectional populationbased survey in France

Nathalie Bajos, Florence Jusot, Ariane Pailhé (), Alexis Spire, Claude Martin, Laurence Meyer (), Nathalie Lydié, Jeanna-Eve Franck, Marie Zins and Fabrice Carrat
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Nathalie Bajos: IRIS - Institut de Recherche Interdisciplinaire sur les enjeux Sociaux - sciences sociales, politique, santé - EHESS - École des hautes études en sciences sociales - INSERM - Institut National de la Santé et de la Recherche Médicale - CNRS - Centre National de la Recherche Scientifique - Université Sorbonne Paris Nord
Florence Jusot: LEDa - Laboratoire d'Economie de Dauphine - IRD - Institut de Recherche pour le Développement - Université Paris Dauphine-PSL - PSL - Université Paris Sciences et Lettres - CNRS - Centre National de la Recherche Scientifique
Ariane Pailhé: INED - Institut national d'études démographiques
Nathalie Lydié: Direction des maladies infectieuses - Infectious Diseases Division [Saint-Maurice] - Santé publique France - French National Public Health Agency [Saint-Maurice, France]
Jeanna-Eve Franck: iPLESP - Institut Pierre Louis d'Epidémiologie et de Santé Publique - INSERM - Institut National de la Santé et de la Recherche Médicale - SU - Sorbonne Université, IRIS - Institut de Recherche Interdisciplinaire sur les enjeux Sociaux - sciences sociales, politique, santé - EHESS - École des hautes études en sciences sociales - INSERM - Institut National de la Santé et de la Recherche Médicale - CNRS - Centre National de la Recherche Scientifique - Université Sorbonne Paris Nord
Fabrice Carrat: iPLESP - Institut Pierre Louis d'Epidémiologie et de Santé Publique - INSERM - Institut National de la Santé et de la Recherche Médicale - SU - Sorbonne Université

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Abstract: Background Significant differences in COVID-19 incidence by gender, class and race/ethnicity are recorded in many countries in the world. Lockdown measures, shown to be effective in reducing the number of new cases, may not have been effective in the same way for all, failing to protect the most vulnerable populations. This survey aims to assess social inequalities in the trends in COVID-19 infections following lockdown. Methods A cross-sectional survey conducted among the general population in France in April 2020, during COVID-19 lockdown. Ten thousand one hundred one participants aged 18–64, from a national cohort who lived in the three metropolitan French regions most affected by the first wave of COVID-19. The main outcome was occurrence of possible COVID-19 symptoms, defined as the occurrence of sudden onset of cough, fever, dyspnea, ageusia and/or anosmia, that lasted more than 3 days in the 15 days before the survey. We used multinomial regression models to identify social and health factors related to possible COVID-19 before and during the lockdown. Results In all, 1304 (13.0%; 95% CI: 12.0–14.0%) reported cases of possible COVID-19. The effect of lockdown on the occurrence of possible COVID-19 was different across social hierarchies. The most privileged class individuals saw a significant decline in possible COVID-19 infections between the period prior to lockdown and during the lockdown (from 8.8 to 4.3%, P = 0.0001) while the decline was less pronounced among working class individuals (6.9% before lockdown and 5.5% during lockdown, P = 0.03). This differential effect of lockdown remained significant after adjusting for other factors including history of chronic disease. The odds of being infected during lockdown as opposed to the prior period increased by 57% among working class individuals (OR = 1.57; 95% CI: 1.00–2.48). The same was true for those engaged in in-person professional activities during lockdown (OR = 1.53; 95% CI: 1.03–2.29). Conclusions Lockdown was associated with social inequalities in the decline in COVID-19 infections, calling for the adoption of preventive policies to account for living and working conditions. Such adoptions are critical to reduce social inequalities related to COVID-19, as working-class individuals also have the highest COVID-19 related mortality, due to higher prevalence of comorbidities.

Keywords: Social inequalities; Lockdown; COVID-19; General population; Risk factors (search for similar items in EconPapers)
Date: 2021
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Published in BMC Public health, 2021, 21 (705)

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Persistent link: https://EconPapers.repec.org/RePEc:hal:journl:hal-04221723

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