• Matthew Keeble, Jean Adams, and Thomas Burgoine.
• MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK. Electronic address: matthew.keeble@mrc-epid.cam.ac.uk.
• Lancet. 2022 Nov 1; 400 Suppl 1: S54S54.

BackgroundFood 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.MethodsIn 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.FindingsAcross 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.InterpretationDuring 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.FundingNational Institute for Health Care Research School for Public Health Research, Medical Research Council.Copyright © 2022 Elsevier Ltd. All rights reserved.

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