Social Inequalities and Dynamics of the COVID-19 Epidemic: Evidence from France

Background: Our main objective was to study the early social dynamics of the COVID-19 epidemic in France, taking into account gender, class, and ethnicity inequalities in living conditions. Methods: A random population-based survey was conducted in France in May 2020, during and post COVID-19 lockdown, in which 77,588 participants aged 18-64 were included in this study. We used multinomial regressions to identify changes in social position and exposure factors associated with symptoms of anosmia/ageusia during the first epidemic peak in late March and thereafter. Findings: In all, 2,045 (1.53% (95%CI 1.46%-1.61%)) participants reported anosmia/ageusia (1.13% during the epidemic peak and 0.40% after), with strong variations according to regions. Women and ethno-racial minorities remained at higher risk of anosmia/ageusia during and after the peak. Whereas senior executive professionals were more affected than lower social classes at the peak of the epidemic, this effect disappeared afterwards. Adjusting on key exposure factors substantially attenuated these associations, except for gender differences. While high density of the place of residence was associated with anosmia/ageusia during the peak, but no longer after, the opposite trend was observed for living in overcrowded housing. Having worked outside the home during lockdown was the most strongly associated exposure factor, and even more so after the peak. Interpretation: The shift in the social profile of the epidemic was related to a shift in exposure factors under the implementation of stringent collective prevention measures. Our results notably stress the importance of working outside the home, all the more so in essential occupations. Funding Statement: Inserm (Institut National de la Sante et de la Recherche Medicale). French Ministry for Research. Drees. Dr. Bajos has received funding from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme (grant agreement No. [856478]) Declaration of Interests: None. Ethics Approval Statement: The survey was approved by the CNIL (French independent administrative authority responsible for data protection) on April 25th 2020 (ref: MLD/MFI/AR205138) and by the “Comite de protection des personnes” (French equivalent of the Research Ethics Committee) on April 24th. The survey also obtained an agreement from the “Comite du Label de la statistique publique”, proving its adequacy to statistical quality standards.