1. Introduction
The sudden and widespread coronavirus disease (COVID-19) pandemic has had a wide-ranging impact on the social economy and people’s daily lives worldwide. According to the statistics reported by World Health Organization (WHO), as of 19 April 2022, there have been more than 0.5 billion confirmed cases of COVID-19 globally, including more than a million deaths. In China, from 3 January 2020 to 19 April 2022, there were 979,966 confirmed cases of COVID-19, with 14,661 deaths. The faster than expected spread of the COVID-19 pandemic has seriously affected the prospects of global economic growth and the confidence of all parties [
1]. Meanwhile, the COVID-19 pandemic has also widely affected individuals’ lifestyle and health behaviors, such as physical activity and sedentary time [
2], social activity and leisure time [
3,
4], and sleep problems [
5,
6]. Although a few studies have investigated the effects of the COVID-19 pandemic on people’s dietary behaviors in developed countries [
7,
8], research regarding the effects of the pandemic on the dietary consumption of residents in developing countries like China is still limited. Given that dietary consumption is closed correlated to diseases (e.g., cardiovascular disease and cancer) and mortality risk [
9], it is of considerable importance to examine the dietary consequences of the COVID-19 pandemic in China. The findings also have crucial implications for developing countries or regions with similar social contexts.
There are a variety of determinants of people’s dietary consumption, such as food supply, food price, socioeconomic factors (e.g., family size and income), individuals’ preferences, and health knowledge [
10,
11,
12]. COVID-19 has been a new driving factor of individuals’ dietary behaviors after the pandemic outbreak. Theoretically, the COVID-19 pandemic can affect dietary consumption among Chinese residents in the following ways. First, the impact of the COVID-19 pandemic on food supply cannot be ignored. In order to limit the spread of the COVID-19 pandemic and ensure the safety of people’s lives and property, the Chinese government has taken relatively strict control measures to restrict population movement and create roadblocks [
13,
14]. If an outbreak of the COVID-19 pandemic occurs somewhere, the government will close public places and restrict people’s movement to prevent the spread of the disease caused by crowds gathering together [
15]. These restrictions have prevented the COVID-19 virus from spreading widely, but they have also seriously affected the industries of grain planting, animal husbandry, agricultural product processing, and food logistics [
16]. The international COVID-19 pandemic is also worrying, with several categories of food imports decreasing to a certain extent [
17]. As a result, these measures negatively influence the amount of domestic food supply, which could reduce the quantity of residents’ food consumption and the diversity of food choices.
Second, as domestic demand declines due to the COVID-19 pandemic struck, a large number of residents are at risk of losing their jobs. Meanwhile, the delayed resumption of work reduces the effective working hours of most workers, which leads to a reduction in family income [
18]. The decline in income can further strengthen the budgetary constraints faced by residents, reduce their capability to purchase high-quality food, and subsequently have a negative effect on the dietary patterns of residents, including quantity, quality, and diversity of food consumption [
19].
Third, the COVID-19 pandemic may increase uncertainty about the future and change residents’ dietary behaviors due to their risk preferences. When residents face sudden public health events and under the situation of incomplete information, for rational consideration, they may increase their current healthy consumption to improve their ability to resist risks [
20,
21]. The most convenient way of healthy consumption is to adjust the dietary pattern and increase food consumption, especially healthy food with high protein and rich micronutrients.
In addition, residents may also tend to have a more balanced diet due to some behavioral changes during the pandemic. For example, given that the COVID-19 pandemic results in constraints on physical activities due to the lockdown [
22], people may adjust their dietary behavior as an alternative measure to maintain physical fitness. Evidence has also shown that households have more careful food planning and management since they have to stay and cook at home during the lockdown [
23]. As such, people might also pay more attention to the nutritional values of the food they cook at home.
Overall, according to the aforementioned mechanisms underlying the relationships between the COVID-19 and people’s dietary consumption, it still remains an open question of the direction and magnitude of the pandemic’s impacts on dietary consumption. However, it is clear that the COVID-19 pandemic could have positive dietary effects on residents who have suffered relatively mild impacts of the pandemic on wage income, food supply, population mobility, and those who have significantly increased their consciousness of a healthy diet.
Up to the present, a few studies have examined the impact of the COVID-19 pandemic on food consumption in China. However, past research has mainly focused on a specific type of food consumption or a specific region (province) [
24,
25]. Different from previous studies, this study aims to examine the dietary consequences of the COVID-19 pandemic among Chinese residents, focusing on a variety of foods and using a nationally representative sample. Specifically, based on the provincial-level panel data from 2015 to 2020, this study employed two-way fixed effects (FE) models to examine the impacts of the COVID-19 pandemic on eight categories of food consumption. Further, we also investigated the heterogeneous effects of the pandemic on residents’ dietary consumption in urban–rural areas, different regions, different proportions of older adults, and different education levels. The results showed that the COVID-19 pandemic has increased Chinese residents’ consumption of healthy food, such as eggs and dairy products. The pandemic has negatively affected people’s consumption of red meat (with high-fat content). In addition, the positively dietary effects of the COVID-19 pandemic were more prominent for residents living in rural areas, eastern regions, regions with a high old-age dependency ratio and a low illiterate rate, and those who consumed a low level of food.
This study contributes to the literature by investigating the impacts and heterogeneity of the COVID-19 pandemic on residents’ dietary consumption in China. The findings can not only shed light on the changes in lifestyle behaviors during the pandemic, but also provide policy implications to improve public health by implementing evidence-based interventions to promote a healthy diet, especially for residents who are lack health knowledge and financially vulnerable.
The rest of this article is organized as follows.
Section 2 describes the data and methods and reports the descriptive statistics.
Section 3 presents the main results of the empirical analysis.
Section 4 discusses the results, and
Section 5 gives the conclusions of this study.
3. Results
Table 1 presents the descriptive characteristics of the full sample and two subgroups defined by the timing of the outbreak of the COVID-19 pandemic (i.e., 2015~2019 and 2020). The results showed that most categories of food consumption among urban and rural residents increased after the outbreak of the COVID-19 pandemic. Without controlling for covariates, the per capita consumption of grain, poultry, and eggs was significantly larger in 2020 than the average consumption from 2015 to 2019, respectively. Specifically, the consumption of grain, poultry, and eggs increased by 6.2% (
p < 0.05), 19.9% (
p < 0.05), and 18% (
p < 0.01) for urban residents and 7.2% (
p < 0.05), 34.6% (
p < 0.01), and 25.1% (
p < 0.01) for rural residents, respectively. Comparatively, the changes in these food consumptions were more pronounced for rural areas than urban areas. The results of the group comparison also showed that the red meat consumption for both urban and rural areas in 2020 was lower than the average consumption from 2015 to 2019, though it was not statistically significant. The results also showed significant between-group differences in per capita GDP (
p < 0.1), child dependency ratio (
p < 0.1), and old-age dependency ratio (
p < 0.01).
Given that the differences in dietary consumption before and after the COVID-19 pandemic might be confounded by time and regional factors, we implemented a multiple regression analysis controlling for provincial fixed effects and year fixed effects and related covariates (provincial characteristics). The regression estimates of the two-way fixed effects models are shown in
Table 2. In Panel A, it can be found that the COVID-19 pandemic had significant positive impacts on the consumption of grain (
p < 0.01), poultry (
p < 0.05), eggs (
p < 0.01), and dairy (
p < 0.05) in urban areas. In contrast, it had a significant negative effect on red meat consumption (
p < 0.05). Specifically, for every 100% increase in the confirmed counts of COVID-19, the urban consumption of grain, poultry, eggs, and dairy increased by 1.5%, 1.6%, 2.2%, and 1.0% respectively, whereas the red meat consumption decreased by 1.1%. In terms of food consumption in rural areas, the results showed that the pandemic significantly increased rural consumption of grain (
p < 0.01), poultry (
p < 0.01), aquatic products (
p < 0.01), eggs (
p < 0.01), and dairy (
p < 0.05) by 2.2%, 2.8%, 1.3%, 2.9%, and 2.0%, respectively, when the number of confirmed cases increases by 100%. Meanwhile, the pandemic also negatively affected the consumption of red meat (−1.7%,
p < 0.1) among rural residents. Comparatively, the effect size of COVID-19 on residents’ food consumption was more prominent in rural areas than in urban areas.
Table 3 reports the estimates of fixed effects models for urban and rural residents in the eastern, central, and western regions, respectively. In terms of urban areas, the results in Panel A demonstrated that the COVID-19 pandemic had significant and positive impacts on the residents’ consumption of grain (
p < 0.01), poultry (
p < 0.01), eggs (
p < 0.01), and dairy (
p < 0.01) in the eastern region of China, while it was not significantly associated with most categories of food consumption in the central and western regions. Similarly, the estimates in Panel B showed that the pandemic positively affected rural residents’ consumption of grain (
p < 0.01), poultry (
p < 0.01), eggs (
p < 0.01), dairy (
p < 0.05), and vegetables (
p < 0.01) in the eastern region, while it negatively influenced red meat consumption (
p < 0.01). As for the central and western regions, the proxy variable of the COVID-19 pandemic was not significant for most categories of food consumption. Comparatively, the marginal effects of the pandemic on residents’ dietary consumption were larger for rural areas than urban areas, which was consistent with our baseline regressions. Overall, the results of stratified analysis by region suggested that the impacts of the COVID-19 pandemic on people’s dietary consumption (no matter positive or negative) were more pronounced for residents who lived in the eastern region than those in the central and western regions.
Table 4 presents the estimated results for subgroups defined by high-level (above the median) and low-level (below the median) old-age dependency ratios for urban areas and rural areas, respectively. In Panel A, the estimated results suggested that the pandemic was significantly associated with most categories of food consumption in urban areas with a high old-age dependency ratio, including increasing consumption of grain (
p < 0.01), poultry (
p < 0.01), eggs (
p < 0.01), dairy (
p < 0.01), vegetables (
p < 0.01), and fruits (
p < 0.1) and reducing red meat consumption (
p < 0.01). For urban areas with a low old-age dependency ratio, however, the pandemic was not statistically significant for all categories of food consumption in this study. In Panel B, the results also showed that the COVID-19 pandemic had more prominent impacts on rural residents’ food consumption in regions with a high old-age dependency ratio than regions with a low proportion of old adults. Specifically, the proxy variable for the COVID-19 pandemic was significant for grain (
p < 0.01), red meat (
p < 0.01), poultry (
p < 0.01), eggs (
p < 0.01), and vegetables (
p < 0.05) for rural residents living in regions with high old-age dependency ratio, while it was only significant for grain (
p < 0.01) and poultry (
p < 0.01) with smaller effect sizes for rural areas with low old-age dependency ratio.
Table 5 shows the estimated results of the heterogeneity analysis by illiteracy rate (above or below the median), which were helpful in exploring the differences in responses to dietary consumption between high-level and low-level education. The results in Panel A demonstrated that the COVID-19 pandemic was not statistically significant for all the eight categories of food consumption in urban areas with high illiteracy rates, whereas it was significantly associated with urban residents’ consumption of grain (
p < 0.01), red meat (
p < 0.01), poultry (
p < 0.01), eggs (
p < 0.01), and dairy (
p < 0.01) in urban regions with low-illiteracy rate. Similar results were found in rural areas. As shown in Panel B, the pandemic had positive effects on rural residents’ consumption of grain (
p < 0.01), poultry (
p < 0.01), aquatic products (
p < 0.05), and eggs (
p < 0.01), and negative impacts on red meat (
p < 0.01) in regions with a low illiteracy rate, while it was only positively linked to grain (
p < 0.1) and poultry (
p < 0.01) with relatively small effect sizes in regions with a high illiteracy rate. Therefore, it can be found that the impacts of the pandemic on people’s dietary consumption, including the quantity and diversity of food consumption, were more salient for regions with low illiteracy rates in comparison with those with high illiteracy rates.
Table 6 presents the estimated results of quantile regressions for panel data, controlling for provincial fixed effects and year fixed effects, as well as the aforementioned covariates. Generally, the results in Panel A for urban areas and Panel B for rural areas were consistent. Although the differences between different quantiles of food consumption were not very prominent, the results demonstrated that the COVID-19 pandemic had slightly larger impacts on residents’ food consumption with low quantiles (e.g., 10th quantile) than that with high quantiles (e.g., 90th quantile). Specifically, for urban residents, the pandemic had larger positive effects on people’s consumption of grain, poultry, eggs, and dairy for those who previously consumed relatively low levels of the corresponding foods. Similarly, the COVID-19 pandemic was also more effective in increasing the consumption of grain, poultry, aquatic products, eggs, and dairy for rural residents who had low levels of consumption of these food categories. As such, the results of quantile regressions for panel data suggested that the pandemic’s effects on people’s diets were larger for those who had low levels of food consumption than high levels. This implies that there was a diminishing marginal effect of the impacts of the pandemic on people’s dietary consumption.
The proxy variable for COVID-19 was the confirmed counts in the above empirical analysis.
Table 7 shows the results of robustness checks using alternative measures of the COVID-19 pandemic, including the number of suspect cases and dead cases. The estimated results were consistent with our main findings. Specifically, the results in Panel A demonstrated that the pandemic positively affects a number of categories of urban residents’ food consumption, especially grain, poultry, and eggs. The results also demonstrated that the pandemic positively influenced residents’ consumption of dairy and vegetables, depending on the COVID-19 proxy considered. In panel B, it can be found that the alternative proxy variables of the COVID-19 pandemic were positively significant for grain, poultry, aquatic products, eggs, and dairy, and negatively significant for red meat. Comparatively, the effect sizes of the pandemic on people’s dietary consumption were larger for rural residents than urban ones.
To account for the variations in food prices due to the COVID-19 pandemic, we further controlled for the food price variable as another robustness check. The food prices were measured using the price index of each category of food examined in our study, which was drawn from the CSY released by NBSC.
Appendix A Table A1 presents the estimation results. Once again, the results on the dietary consequences of the COVID-19 pandemic were consistent with our baseline regressions. Comparatively, the positive effects of the pandemic on residents’ dietary consumption were slightly larger when taking food price into account, suggesting that food price changes could be a potential channel underlying the relationship between the COVID-19 pandemic and residents’ dietary consumption.
4. Discussion
Using the provincial-level panel data from 2015 to 2020, which is a national representative sample released by NBSC, this study employed two-way fixed effects models to investigate the impacts of the COVID-19 pandemic on dietary consumption among Chinese residents. The confirmed counts of COVID-19 were used as the proxy variable for COVID-19. We also conducted heterogeneity analysis by comparing the significant levels and effect sizes of the proxy variable of the COVID-19 pandemic in different subgroups defined by region, old-age dependency ratio, and illiteracy rate. Further, the quantile regression for panel data was applied to examine the heterogeneous effects throughout the conditional distribution of variables regarding food consumption. Finally, instead of using confirmed counts of COVID-19 within a province, we checked the robustness of our main findings using suspect counts and dead counts as alternative measures of the pandemic. As another robustness check, we further controlled for food prices to test the validity of our main findings.
This study found that the COVID-19 pandemic had significant and positive impacts on urban and rural residents’ consumption of grain, poultry, eggs, and dairy, whereas it adversely affected red meat consumption. The results were consistent with a previous study using a survey sample in Jiangsu province, which also found the pandemic increased some categories of food consumption [
25]. One possible reason is that residents may be inclined to consume more food to increase their viability, which is considered a countermeasure to deal with the risk of uncertainty after the outbreak of the COVID-19 pandemic. Meanwhile, people might also pay more attention to a healthy diet, which is beneficial to improving health status and strengthening the body’s immune system. For example, grain products (e.g., wholegrain foods) are a good source of energy, essential fiber, calcium, iron, and vitamins [
33]. Dairy products and eggs are proven to be protein-rich foods, which also deliver concentrated amounts of nutrient vitamins and minerals [
34,
35]. Poultry meat and aquatic foods also provide high-quality protein and micronutrients with low-fat content [
36,
37]. The promotion of health awareness could also be a feasible explanation of the negative association between the pandemic and red meat consumption in this study. Because red meat is a category of food with high-fat content, it can lead to cardiovascular disease with excessive consumption, especially for middle-aged and older adults [
38]. It is also possible that people have to stay at home from work and earn less income due to the pandemic [
39]. Moreover, there could also be a supply shortage for some categories of food due to disruptions to transportation networks and labor shortages [
40], which subsequently increases food prices. As such, residents may not be able to afford the consumption of high-price food (e.g., red meat) and increase the consumption of other food instead, such as grain, eggs, and dairy products. In addition, another probable reason is that the COVID-19-induced lockdown adversely affected residents’ physical activity and increased the frequency of cooking meals at home [
23,
41]. People may, in turn, be more concerned about the nutritional values of the food they cook and develop healthier eating habits to improve their health.
In terms of the heterogeneous impacts of the COVID-19 pandemic on dietary consumption, we found that the dietary consequences of the pandemic (no matter positive or negative) were more pronounced for rural residents compared to their urban counterparts. We interpreted such a finding as a result of the urban–rural difference in the changes in health consciousness regarding food consumption after the outbreak of the COVID-19 pandemic. Past research has shown that urban residents consumed more healthy food (e.g., milk and dairy products) than their rural peers, possibly due to the urban–rural disparities in health awareness, income, and accessibility to such foods [
32]. Thus, compared to their urban counterparts, rural residents could increase health consciousness more significantly and gain more health knowledge through public media after the outbreak of the pandemic. In addition, given that rural residents consumed less healthy food than urban ones, the marginal effect sizes of the pandemic on people’s dietary consumption might be larger for rural residents in comparison with their urban peers. This explanation is also supported by our results of quantile regressions for panel data, which suggested that the COVID-19 pandemic had more positive effects on residents who had low levels of food consumption. That is, the effect sizes of COVID-19 on people’s dietary consumption were diminishing with the increase in food consumption, and people with low levels of healthy food consumption were more prone to be affected by the pandemic.
Our heterogeneity analysis also indicated that the impacts of the pandemic on people’s dietary consumption were more prominent in the eastern region than central and western regions. One plausible reason is that, compared to those living in underdeveloped areas, residents in developed regions were less likely to confront food shortages and serious inflation due to a disrupted food supply chain. In other words, developed regions had more complete logistics and retail systems to ensure sufficient food supply and stabilize food prices under emergency circumstances [
42]. Hence, the positive effects on health consciousness were more salient for residents living in the eastern region than those in the central and western areas. In addition, we also found heterogeneous effects of the pandemic on people’s dietary consumption by old-age dependency ratio and illiteracy rate. To be specific, the impacts of the pandemic on people’s food consumption were larger for the regions with a high old-age dependency ratio and a low illiteracy rate. A reasonable explanation is that the increase in consciousness of a healthy diet was more prominent for older adults and people with high levels of education after the outbreak of the COVID-19 pandemic. Elderly people are more vulnerable to have serious illnesses during the pandemic, whereas highly educated people are more sensitive and better at adjusting their dietary behaviors to the changes in the public health environment [
43,
44,
45,
46].
Our findings have several implications for policy improvement. First, although this study found positive impacts of the pandemic on dietary consumption among Chinese residents, the effect sizes were relatively small. Meanwhile, some categories of food consumption (e.g., vegetables and fruits) were not significantly affected in the full sample. Therefore, the promotion and universal education on a healthy diet are still needed, especially for residents with low levels of education. Many publicity measures are encouraged, such as posting announcements for a healthy diet in public places (e.g., billboards in neighborhoods and bus stations) and organizing public lectures on knowledge of a healthy diet. Second, relevant actions should be implemented to reduce the unemployment rate during the pandemic and ensure residents’ jobs and income for a basic livelihood, particularly in underdeveloped regions with a large number of residents living in relative poverty. In addition, for the vulnerable population such as older adults, targeted cash transfer programs are needed to be implemented if government financial resources permit. Third, it is also necessary to strengthen the construction of logistics systems and warehousing infrastructure (especially in less developed regions), which is crucial to juggling the logistics of supplying food.
This study also has some limitations due to data constraints. First, although our study focused on a variety of food categories, we may not have fully uncovered the relationships between the COVID-19 pandemic and all types of food consumption. In addition, we only investigated the quantity of different categories of food consumption, the diversity and quality of dietary consumption were not discussed in depth due to the lack of relevant data. Second, although we indirectly confirmed possible reasons why the pandemic affected the dietary consumption among Chinese residents through heterogeneity analysis, we were not able to directly attribute the total effects of the pandemic on people’s dietary consumption due to data limitations, such as the income effect, health awareness effect, food supply and prices, and other behavioral changes (e.g., physical activity and cooking). Third, given that the newest data used in this study were recorded in 2020, the main findings of the current research can only reflect the short-term effects of the pandemic on people’s dietary consumption. The long-term impacts of the pandemic remain to be explored. Therefore, our findings should be interpreted and generalized with caution. More relevant studies regarding the behavioral changes induced by the COVID-19 pandemic are encouraged.