When lockdown policies amplify social inequalities in COVID-19 infections. Evidence from a cross-sectional population-based survey in France

BAJOS, Nathalie

ObjectivesTo assess social inequalities in the trends in COVID-19 infections following lockdown DesignA cross-sectional survey conducted among the general population in France in April 2020, during COVID-19 lockdown. Participants10 401 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. Main outcomeThe 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 three 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. ResultsIn all, 1,304 (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 contaminated during lockdown as opposed to the prior period increased by 57% among working class individuals (OR=1.57; 95% CI: 1.0-2.48). The same was true for those engaged in in-person professional activities during lockdown (OR=1.53; 95% CI: 1.03-2.29). InterpretationLockdown 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. Section 1: What is already known on this topicSignificant differences in COVID-19 incidence by gender, class and race/ethnicity are recorded in many countries in the world. Lockdown measures implemented throughout the globe have been effective in reducing transmission risks. Section 2: What this study addsOur study shows that lockdowns impact was socially differentiated and has benefited the working classes the least. Such results underline the need to design COVID-19 preventive policies that take into account living and working conditions, as working-class individuals also have the highest COVID-19 related mortality, due to higher prevalence of comorbidities.