JMIR Publications

ABSTRACT

Background:

In December 2022, in light of the weakened pathogenicity of the new variants and other scientific considerations, China optimized its Zero-COVID Policy. As the situation evolved, the virus spread more widely across the country.

Objective:

This study aims to assess public’s sleep status and its association with purchasing behavior of COVID-19 medicine after the adjustment of Zero-COVID Policy in China.

Methods:

A cross-sectional, internet-based survey among residents aged 18-69 was conducted in Zhejiang Province, China, from December 16 to 30, 2022, to collect data on sociodemographic characteristics, COVID-19 drug purchasing behavior, sleep disturbance levels, etc. Chi-square tests, univariate analyses and multivariate analyses were used to explore the associations among these factors.

Results:

Out of 38,480 participants, 20,803 (54.1%) reported sleep disruption after China's COVID - 19 response policy adjustment. The degree of impact varied, with 10,964 (52.7%) reporting “slight”, 3,105 (14.9%) “moderate”, 3,493 (16.8%) “significant”, and 3,241 (15.6%) “very significant”. Only 20.9% (782/3,742) of those who deemed purchasing unnecessary had sleep disruptions, compared to 45.2% (6,214/13,752) of those who acquired medications and 65.8% (13,807/20,986) of those who tried but failed to obtain them. Sleep disturbance levels were significantly associated with sociodemographic factors like age, education levels, occupation, marital status, and presence of family members diagnosed with COVID-19 (P <.05). By age, sleep disturbance proportions differed notably: 36.3% (409/1,126) for those under 20 years old, 54.8% (19,714/35,970) for the 20–60 age group, and 49.1% (680/1,384) for individuals over 60. For education level, the proportions were 57.4% (517/900, primary school), 54.3% (3,928 /7,229, junior high school), 54.3% (3,808/7,017, senior high school), 54.0% (11,974/22,180, junior college/undergraduate), and 49.9% (576/1,154, master’s degree), showing a clear downward trend as education level increased. By occupation, farmers had the highest rate (855/1,447, 59.1%), followed by business/service industry workers/stay-at-home/unemployed individuals (13,925/24,750, 56.3%), government staff (4,161/7,712, 54.0%), while 1,242 out of 3,049 health workers (40.7%) and 620 out of 1,522 students (40.7%) had lower rates. Married participants had a 55.2% (17,143/31,053) sleep disturbance rate, and those with COVID-positive family members had the highest rate (2,023/2,873, 70.4%). Multivariate Logistic regression, adjusting for these sociodemographic factors, showed that compared to those who thought purchasing COVID-19 medications was unnecessary, those who acquired medications were 3.11 times (aOR 3.11, 95% CI 2.85–3.39) more likely, and those who tried but couldn't get medications were 7.11 times (aOR 7.11, 95% CI 6.53–7.74) more likely to experience sleep disturbance.

Conclusions:

The adjustment of China's zero-COVID policy had affected sleep health of the public which were closely linked to drug-purchasing status, especially among the elderly, those with lower education level, those with family members diagnosed with COVID-19. It highlighted the need to develop and deploy interventions aimed at promoting better sleep health in times of crisis.