Background Social inequalities in health care during the COVID-19 pandemic have been observed in quantitative and qualitative studies. How the accumulation and/or combination of socially advantageous or disadvantageous factors affect health care experiences is less well understood.

Methods We analysed health & social care experiences in a United Kingdom community-based cohort, COVID Symptom Study Biobank, from a combination of closed questions detailing health & social care access issues (N = 3516) and open questions asking about care received for COVID-19 for a selected subset (N = 335) in an August 2022 questionnaire. Free text responses on COVID-19 care experiences were qualitatively coded using a deductive approach to appraise need for care, descriptions of care (receipt of care) and perceptions of care (adequacy, quality, ease of access). Measures of relative social disadvantage and advantage were constructed from pre-pandemic factors (sex, ethnic group, education level, employment status, local area deprivation). In both analysis subsets, associations between social factors and care experiences were estimated quantitatively with multivariable poisson regression models. Models weighted for inverse probability of participation and selection and adjusted for potential confounders.

Results Relatively disadvantaged participants (such as female sex participants with lower education level living in more deprived areas), were more likely to report health & social care access issues, with dose-response relationships observed with increasing disadvantage – 26-42% experienced one or more issues (Relative risk ratio, RR = 1.19, 95% CI: 1.08-1.31, per additional form of disadvantage, for an outcome of one or more of 5 issues). Social gradients in care were also observed in qualitatively coded free-text data for a subset with self-reported symptomatic COVID-19. Multiply disadvantaged participants were more likely to describe needing care for their COVID-19 illness (RR = 1.10, 95% CI: 0.96-1.26, per additional form of disadvantage). Among those needing care, more disadvantaged participants were less likely to report receiving any care (RR = 0.91, 95% CI: 0.82-1.01), and less likely to report positive care experiences and easy access to care.

Conclusion ‘Double disadvantage’ was found for with individuals with greater social disadvantage prior to the pandemic, having greater need for health care but worse experiences of care. Results suggest work is needed to address structures in the UK health care system that underly these inequalities.