Repository logo

Changes in online food access during the COVID-19 pandemic and associations with deprivation: a longitudinal analysis.

Accepted version

No Thumbnail Available



Change log


Keeble, Matthew 
Adams, Jean 
Burgoine, Thomas 


BACKGROUND: Food prepared out-of-home is typically energy dense and nutrient poor. Online food delivery services such as Just Eat and Deliveroo facilitate access to this food. The number of outlets accessible through these services reportedly increased in England during the COVID-19 pandemic, possibly exacerbating inequalities in access to unhealthy food. We investigated changes in online food outlet access, and the extent to which they were socioeconomically patterned throughout the COVID-19 pandemic. METHODS: In November, 2019, and monthly between June, 2020, and March, 2022, we used automated methods to construct a dataset containing information about all outlets in England registered to accept orders through the company Just Eat. Across 2118 postcode districts, we identified the number of accessible outlets. We used a negative binomial generalised estimating equation to investigate changes in the number of accessible outlets over time, adjusting for population density, the number of food outlets in the physical food environment, and rural urban classifications. We stratified analyses by deprivation quintile (Q). All data were publicly available. FINDINGS: Across England, the median number of outlets accessible online decreased from 63·5 (IQR 16·0-156·0) in November, 2019, to 57·0 (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 (104·0-292·0) in the most deprived areas (Q5) compared to 27·0 (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 (incidence rate ratio [IRR)] 1·10 [1·07-1·13]). By contrast, in the least deprived areas, we estimated a 19% decrease (IRR 0·81 [0·79-0·83]) in food outlets. INTERPRETATION: During the first 2 years of the COVID-19 pandemic, the number of food outlets accessible online increased only in the most deprived areas. We could not determine the extent to which the changes we observed were already underway. Nevertheless, increased online food outlet access might prompt unhealthy food consumption and undermine public health interventions implemented in the physical food environment. Further research could examine changes in the type of food outlets accessible online and through our dataset, seek to understand the extent to which changes in access are associated with changes to food practices, diet quality, and health. FUNDING: National Institute for Health Care Research School for Public Health Research, Medical Research Council.



Humans, Pandemics, COVID-19, Food, Diet, Environment, Residence Characteristics, Fast Foods

Journal Title


Conference Name

UK Public Health Science Meeting

Journal ISSN


Volume Title



Elsevier BV
Economic and Social Research Council (ES/G007462/1)
MRC (MC_UU_00006/7)
Department of Health (via National Institute for Health Research (NIHR)) (PD-SPH-2015-10029 BH154142)
Matthew Keeble was funded by the National Institute for Health and Care Research School for Public Health Research (grant number PD_SPH_2015). This work was supported by the Medical Research Council (grant number MC_UU_00006_7). The views expressed are those of the authors and not necessarily those of any of the above named funders. The funders had no role in the design of the study and collection, analysis, and interpretation of the data. The authors confirm that this is original, previously unpublished research that has not been submitted elsewhere.