Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Aug 10, 2022
Date Accepted: Feb 23, 2023
Date Submitted to PubMed: Feb 27, 2023
Changes in online food access during the COVID-19 pandemic and associations with deprivation: a longitudinal analysis
ABSTRACT
Background:
Food prepared out-of-home is typically energy-dense and nutrient-poor. Online food delivery services have become a popular way to purchase this food. The number of food outlets that can be accessed (ordered from) through these services can influence how frequently they are used to purchase the unhealthy food typically available. The extent to which online food access changed in England during the COVID-19 pandemic is unclear.
Objective:
We aimed to investigate monthly changes in online access to food prepared out-of-home in England during the first two years of the COVID-19 pandemic compared with pre-pandemic levels. We also aimed to understand the extent to which any changes were associated with deprivation.
Methods:
In November 2019, and monthly between June 2020 and March 2022, we used innovative automated data collection to construct a dataset containing information about all food outlets in England registered to accept orders through the leading online food delivery service. Across postcode districts (n=2118), we identified the number and percentage of food outlets registered to accept orders online, and the number that was accessible. We used generalized estimating equations (adjusted for population density, the number of food outlets in the physical food environment, and rural urban classifications) to investigate changes in each outcome compared to pre-pandemic levels (November 2019). We stratified analyses by deprivation quintile (Q).
Results:
Across England, the summed number of food outlets registered to accept orders online increased from 29,232 in November 2019 to 49,752 in March 2022. The median percentage of food outlets registered to accept orders online increased from 14.3 (IQR: 3.8, 26.0) in November 2019 to 24.0 (IQR: 6.2, 43.5) in March 2022. The median number of accessible food outlets decreased from 63.5 (IQR: 16.0, 156.0) in November 2019 to 57.0 (IQR: 11.0, 163.0) in March 2022. However, we observed variation across deprivation quintiles. In March 2022, the median number of outlets accessible online was 175.0 (IQR; 104.0, 292.0) in the most deprived areas (Q5) compared to 27.0 (IQR: 8.5, 60.5) in the least deprived (Q1). In adjusted analyses, we estimated that the number of outlets accessible online in the most deprived areas was 10% higher in March 2022, compared to November 2019 (IRR: 1.10; 95% CI: 1.07, 1.13). In contrast, in the least deprived areas, we estimated a 19% decrease (IRR: 0.81; 95% CI: 0.79-0.83).
Conclusions:
The number of food outlets accessible online increased only in the most deprived areas in England. Future research might attempt to understand the extent to which changes in metrics of online food outlet access during the COVID-19 pandemic were associated with changes in online food delivery service use, and in turn, implications on diet quality and health.
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