TY - JOUR

T1 - The association between community-based self-reported COVID-19 symptoms and social deprivation explored using symptom tracker apps

T2 - A repeated cross-sectional study in Northern Ireland

AU - McKinley, Jennifer M.

AU - Cutting, David

AU - Anderson, Neil

AU - Graham, Conor

AU - Johnston, Brian

AU - Mueller, Ute

AU - Atkinson, Peter

AU - van Woerden, Hugo

AU - Bradley, Declan T.

AU - Kee, Frank

PY - 2021/6/22

Y1 - 2021/6/22

N2 - Objectives: The aim of the study was to investigate the spatial and temporal relationships between the prevalence of COVID-19 symptoms in the community and area-level social deprivation. Design: Spatial mapping, generalised linear models, using time as a factor, and spatial-lag models were used to explore the relationship between self-reported COVID-19 symptom prevalence as recorded through two smartphone symptom tracker apps and a range of socio-economic factors using a repeated cross-sectional study design. Setting: In the community in Northern Ireland, UK. The analysis period included the earliest stages of non-pharmaceutical interventions and societal restrictions or ‘lockdown’ in 2020. Participants: Users of two smartphone symptom tracker apps recording self-reported health information who recorded their location as Northern Ireland, UK. Primary outcome measures: Population standardised self-reported COVID-19 symptoms and correlation between population standardised self-reported COVID-19 symptoms and area-level characteristics from measures of multiple deprivation including employment levels and population housing density, derived as the mean number of residents per household for each census super output area. Results: Higher self-reported prevalence of COVID-19 symptoms was associated with the most deprived areas (p < 0.001) and with those areas with the lowest employment levels (p < 0.001). Higher rates of self-reported COVID-19 symptoms within the age groups, 18-24 and 25-34 years were found within the most deprived areas during the earliest stages of non-pharmaceutical interventions and societal restrictions (‘lockdown’). Conclusions: Through spatial regression of self-reporting COVID-19 smartphone data in the community this research shows how a lens of social deprivation can deepen our understanding of COVID-19 transmission and prevention. Our findings indicate that social inequality, as measured by area-level deprivation, is associated with disparities in potential COVID-19 infection, with higher prevalence of self-reported COVID-19 symptoms in urban areas associated with area-level social deprivation, housing density and age.

AB - Objectives: The aim of the study was to investigate the spatial and temporal relationships between the prevalence of COVID-19 symptoms in the community and area-level social deprivation. Design: Spatial mapping, generalised linear models, using time as a factor, and spatial-lag models were used to explore the relationship between self-reported COVID-19 symptom prevalence as recorded through two smartphone symptom tracker apps and a range of socio-economic factors using a repeated cross-sectional study design. Setting: In the community in Northern Ireland, UK. The analysis period included the earliest stages of non-pharmaceutical interventions and societal restrictions or ‘lockdown’ in 2020. Participants: Users of two smartphone symptom tracker apps recording self-reported health information who recorded their location as Northern Ireland, UK. Primary outcome measures: Population standardised self-reported COVID-19 symptoms and correlation between population standardised self-reported COVID-19 symptoms and area-level characteristics from measures of multiple deprivation including employment levels and population housing density, derived as the mean number of residents per household for each census super output area. Results: Higher self-reported prevalence of COVID-19 symptoms was associated with the most deprived areas (p < 0.001) and with those areas with the lowest employment levels (p < 0.001). Higher rates of self-reported COVID-19 symptoms within the age groups, 18-24 and 25-34 years were found within the most deprived areas during the earliest stages of non-pharmaceutical interventions and societal restrictions (‘lockdown’). Conclusions: Through spatial regression of self-reporting COVID-19 smartphone data in the community this research shows how a lens of social deprivation can deepen our understanding of COVID-19 transmission and prevention. Our findings indicate that social inequality, as measured by area-level deprivation, is associated with disparities in potential COVID-19 infection, with higher prevalence of self-reported COVID-19 symptoms in urban areas associated with area-level social deprivation, housing density and age.

U2 - 10.1136/bmjopen-2020-048333

DO - 10.1136/bmjopen-2020-048333

M3 - Journal article

VL - 11

JO - BMJ Open

JF - BMJ Open

SN - 2044-6055

IS - 6

M1 - e048333

ER -