Predictors and Consequences of Not Seeking Healthcare during the COVID-19 Pandemic: Findings from the HEAF Cohort.

The COVID-19 pandemic resulted in a dramatic reduction of routine healthcare availability in many European countries. Among a cohort of English middle-aged adults, we explored pre-pandemic and pandemic factors associated with not seeking healthcare during lockdown, and their effect on subsequent self-reported health measures. Longitudinal data from the Health and Employment After Fifty (HEAF) cohort were used. Pre-pandemic data came from the 5th annual follow-up (2019), when participants were aged 56-71 years, and pandemic data were collected by e-survey in February 2021 and November 2021. Response rates of the two e-surveys were 53% and 79%, respectively. Pre-pandemic predictors of not seeking healthcare were: female gender, higher BMI, higher comorbidity, poorer self-rated health and depression; non-care seekers were also more likely to report that family or friends were affected by COVID-19 and to have been advised to shield. Not seeking healthcare during lockdown was associated with a higher risk of reporting worsening of physical, but not mental, health during the later phase of the pandemic. In this cohort, those with generally poorer health were disproportionately more likely to not seek healthcare during lockdown, which may potentially exacerbate pre-existing inequalities and lead to longer-term health consequences.

Pre-pandemic socio-economic status and changes in employment during the first lockdown (2020) on the health of middle-aged people in England: a longitudinal study.

BACKGROUND: The COVID-19 pandemic markedly disrupted people's lives. It caused higher mortality and morbidity amongst individuals from poorer socio-economic position (SEP). It is well-recognised that job loss has a negative impact on health. We hypothesised that health effects of the pandemic on middle-aged people might be different depending on SEP and changes in employment. METHODS: Data are from the Health and Employment After Fifty (HEAF), a cohort recruited 2013-2014 when aged 50-64 through 24 English general practices. At baseline and annually since, participants completed a questionnaire reporting about demographics, employment, health, lifestyle, and finances. In 2021 we sent an e-survey to all contactable HEAF participants, asking about effects of the first lockdown (March-July 2020). Outcomes were participants' perception of worsening of mental, physical health, and self-rated health (SRH) since lockdown. Associations between SEP, COVID-19 related employment changes and health were explored with Poisson regression with robust standard error, with adjustment for age, sex, and pre-pandemic SRH. RESULTS: In total, 2,469 (53%) returned a usable questionnaire, amongst whom 2,344 provided complete information for these analyses (44% men, mean age 65.7 years). Worsening of mental, physical or SRH since lockdown was reported by 21%, 27% and 17% respectively. Mutually adjusted models showed that reporting struggling financially pre-pandemic (versus living comfortably) was associated with an increased risk of deterioration in: mental (RR = 2.0, 95%CI 1.7-2.5), physical health (RR = 2.0, 95%CI 1.6-2.3), and SRH (RR = 1.6, 95%CI 1.2-2.1). Participants working from home during lockdown and those who lost their job (as opposed to those with unchanged employment) were at increased risk of reporting deterioration in mental health and SRH. CONCLUSION: In a cohort of older workers, working from home, job loss and poorer pre-pandemic SEP were all associated with worsening of mental health and SRH since lockdown.

Impact of the COVID-19 pandemic on key workers in England: findings from the Health and Employment After Fifty (HEAF) Study

IntroductionIn the UK, workers who were essential to maintain communications, travel, food and healthcare were deemed ‘key workers’. There is scarce evidence about the effect that the pandemic had on this group of workers as compared with people who were home working, furloughed or retired.ObjectivesTo compare measures of health and lifestyle amongst older key workers as opposed to other older adults working or not working during the pandemic.MethodsIn February 2021 participants in the Health and Employment After Fifty (HEAF) study (aged 55–73) were sent an online survey, enquiring about changes to their mental/physical health and lifestyle during the first UK lockdown (starting late March 2020). Logistic regression was used to explore the association between being a keyworker (healthcare/not healthcare) and adverse outcomes, with adjustment for age and sex. Participants in work but not identifying themselves as key workers were used as the reference category.ResultsA total of 2,040 (46%) returned a usable questionnaire and completed the question about key worker status. 281 were in work but not as key workers;50 were key workers in healthcare;298 were key workers not in healthcare;1,411 were retired. Key workers were predominantly women. Key workers not in healthcare were more likely to see a worsening of mental health (OR=1.6;95%CI 1.0 to 2.4) physical health (OR=1.5;95%CI 1.0 to 2.3), to report that their diet was less healthy (OR=1.8;95% CI 1.2 to 2.8) and to report eating more than pre-lockdown (OR=1.6;95%CI 1.1 to 2.4) compared with participants in work but not as key workers. Associations were similar among key workers in healthcare, however they did not reach statistical significance.ConclusionBeing a key worker during the pandemic (especially not in healthcare) was associated with a deterioration of health and lifestyle choices.