Inequality-related health and social factors and their impact on well-being during the COVID-19 pandemic: findings from a national survey in the UK

Background: Lower socioeconomic groups and disadvantaged populations across the world suffer disproportionately from the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to examine the impact of health-and social inequality-related factors on well-being to further distinguish each of their effects during the pandemic. Methods: A nationally representative sample of 5,077 UK respondents aged 18 years or older was recruited through an online survey panel during the COVID-19 pandemic. Subjective well-being was measured using the 11-point Cantril Ladder of Life Scale. Impact of inequality-related health and social factors (pre-existing medical conditions, household size and occupation), as well as COVID-19-related risk factors (symptoms, infections and social distancing behaviours), on well-being were analysed using multiple lin-20ear regression models. Associations between COVID-19-related risk factors and well-being according to the respondents’ household size and occupation were modelled to test the differences by socioeconomic profile. Results: We identified inverted V-shaped associations between household size and subjective well-being during the COVID-19 pandemic. Compered to single-person house-holds, respondents from households of two to four persons showed better well-being (β= 0.57; CI [0.44, 0.72]), whereas living in crowded households was associated with decreased well-being (β= -0.48; CI [-0.71, -0.25]). Furthermore, lower-skilled occupations (elementary occupations: β= -0.31; CI [-0.58, -0.03]; logistics and transport services: β= -0.37; CI [-0.74, -0.01]) and chronic medical conditions (cardiometabolic or respiratory diseases: β= -0.25; CI [-0.41, -0.1]; mental health conditions: β= 1.12; CI [-1.28, -0.96]) were factors associated with reduced well-being during the pandemic. Inter-actions between positive COVID-19 diagnosis, symptoms and crowded households were identified (β= -0.95; CI [-1.76, -0.14] and β= -4.74; CI [-9.87, -1.61], respectively). Conclusions: In a national sample, levels of general subjective well-being during the COVID-19 pandemic and lockdowns were disproportionately distributed across different groups within society. Preventive policies should explicitly focus on reaching low socioeconomic groups; more emphasis should be placed on the coordination of multisectoral support in order to tackle existing health and social inequalities