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COVID-19 related health inequality exists even in a city where disease incidence is relatively low: a telephone survey in Hong Kong
  1. Roger Yat-Nork Chung1,2,
  2. Gary Ka-Ki Chung2,
  3. Michael Marmot2,3,
  4. Jessica Allen3,
  5. Dicken Chan1,
  6. Peter Goldblatt3,
  7. Hung Wong2,4,
  8. Eric Lai5,
  9. Jean Woo2,5,
  10. Eng-Kiong Yeoh1,2,
  11. Samuel Y S Wong1,2
  1. 1School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
  2. 2CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong, Hong Kong
  3. 3UCL Institute of Health Equity, Research Department of Epidemiology and Public Health, University College London, London, UK
  4. 4Department of Social Work, The Chinese University of Hong Kong, Hong Kong, Hong Kong
  5. 5CUHK Institute of Ageing, The Chinese University of Hong Kong, Hong Kong, Hong Kong
  1. Correspondence to Dr Roger Yat-Nork Chung, School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong 26451, Hong Kong; rychung{at}cuhk.edu.hk

Abstract

Background We examined whether COVID-19 could exert inequalities in socioeconomic conditions and health in Hong Kong, where there has been a relatively low COVID-19 incidence.

Methods 752 adult respondents from a previous random sample participated in a telephone survey from 20 April to 11 May 2020. We examined demographic and socioeconomic factors, worry of COVID-19, general health, economic activity, and personal protective equipment (PPE) and related hygiene practice by deprivation status. The associations between deprivation and negative COVID-19 related issues were analysed using binary logistic regressions, while the associations of these issues with health were analysed using linear regressions. Path analysis was conducted to determine the direct effect of deprivation, and the indirect effects via COVID-19 related issues, on health. Interactions between deprivation and the mediators were also tested.

Results Deprived individuals were more likely to have job loss/instability, less reserves, less utilisation and more concerns of PPE. After adjustments for potential confounders, being deprived was associated with having greater risk of low reserve of face masks, being worried about the disease and job loss/instability. Being deprived had worse physical (β=−0.154, p<0.001) and mental health (β=−0.211, p<0.001) and had an indirect effect on mental health via worry and job loss/instability (total indirect effect: β=−0.027, p=0.017; proportion being mediated=11.46%). In addition, significant interaction between deprivation and change of economic activity status was observed on mental health-related quality of life.

Conclusion Even if the COVID-19 incidence was relatively low, part of the observed health inequality can be explained by people’s concerns over livelihood and economic activity, which were affected by the containment measures. We should look beyond the incidence to address COVID-19 related health inequalities.

  • health inequalities
  • social inequalities
  • poverty
  • deprivation
  • communicable diseases

Data availability statement

Data are available upon reasonable request. The data that support the findings of this study are available on request from the corresponding author, RY-NC. The data are not publicly available due to containing information that could compromise the privacy of research participants.

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

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Data availability statement

Data are available upon reasonable request. The data that support the findings of this study are available on request from the corresponding author, RY-NC. The data are not publicly available due to containing information that could compromise the privacy of research participants.

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Footnotes

  • Correction notice This article has been corrected since it first published. The provenance and peer review statement has been included.

  • Contributors All authors contributed to the write-up of this manuscript. RY-NC oversaw the study and is responsible for the conceptualisation of the study, study design, data collection, data analysis, data interpretation and led the write-up of the manuscript. SYSW and DC are responsible for the data collection, data analysis and data interpretation. GK-KC, MM, JA, PG, HW, EL, JW and E-KY are responsible for the data interpretation.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.