ABSTRACT
Background: Widespread disruptions of medical care to mitigate COVID-19 spread and reduce burden on healthcare systems may have deleterious public health consequences.
Design and Methods: To examine factors contributing to healthcare interruptions during the pandemic, we conducted a COVID-19 impact survey between 10/7-12/14/2020 among participants of the Southern Community Cohort Study, which primarily enrolled low-income individuals in 12 southeastern states from 2002-2009. COVID survey data were combined with baseline and follow-up data.
Results: Among 4,463 respondents, 40% reported having missed/delayed a health appointment during the pandemic; the common reason was provider-initiated cancellation or delay (63%). In a multivariable model, female sex was the strongest independent predictor of interrupted care, with odds ratio (OR) 1.63 (95% confidence interval [CI] 1.40-1.89). Those with higher education (OR 1.27; 95% CI 1.05-1.54 for college graduate vs ≤high school) and household income (OR 1.47; 95% CI 1.16-1.86 for >$50,000 vs <$15,000) were at significantly increased odds of missing healthcare. Having greater perceived risk for acquiring (OR 1.42; 95% CI 1.17-1.72) or dying from COVID-19 (OR 1.25; 95% CI 1.04-1.51) also significantly increased odds of missed/delayed healthcare. Age was inversely associated with missed healthcare among men (OR for 5-year increase in age 0.88; 95% CI 0.80-0.96) but not women (OR 0.97; 95% CI 0.91-1.04; p-interaction=0.04). Neither race/ethnicity nor comorbidities were associated with interrupted healthcare.
Conclusions: Disruptions to healthcare disproportionately affected women and were primarily driven by health system-initiated deferrals and individual perceptions of COVID-19 risk, rather than medical co-morbidities or other traditional barriers to healthcare access.
REFERENCES
Czeisler M, Marynak K, Clarke KEN, et al. Delay or Avoidance of Medical Care Because of COVID-19-Related Concerns – United States, June 2020. MMWR Morb Mortal Wkly Rep 2020;69:1250-7. DOI: https://doi.org/10.15585/mmwr.mm6936a4
Miller MJ, Xu L, Qin J, Hahn EE, et al. Impact of COVID-19 on cervical cancer screening rates among women aged 21-65 years in a large integrated health care system – Southern California, January 1-September 30, 2019, and January 1-September 30, 2020. MMWR Morb Mortal Wkly Rep 2021;70:109-13. DOI: https://doi.org/10.15585/mmwr.mm7004a1
Whaley CM, Pera MF, Cantor J, et al. Changes in health services use among commercially insured US populations during the COVID-19 pandemic. JAMA Netw Open 2020;3:e2024984. DOI: https://doi.org/10.1001/jamanetworkopen.2020.24984
Patel SY, Mehrotra A, Huskamp HA, et al. Trends in outpatient care delivery and telemedicine during the COVID-19 pandemic in the US. JAMA Intern Med 2021;181:388-91. DOI: https://doi.org/10.1001/jamainternmed.2020.5928
Baum A, Kaboli PJ, Schwartz MD. Reduced in-person and increased telehealth outpatient visits during the COVID-19 pandemic. Ann Intern Med 2021;174:129-31. DOI: https://doi.org/10.7326/M20-3026
Findling MG, Blendon RJ, Benson JM. Delayed Care with harmful health consequences—Reported experiences from national surveys during coronavirus disease 2019. JAMA Health Forum 2020;1:e201463-e. DOI: https://doi.org/10.1001/jamahealthforum.2020.1463
Hartnett KP, Kite-Powell A, DeVies J, et al. Impact of the COVID-19 pandemic on emergency department visits – United States, January 1, 2019-May 30, 2020. MMWR Morb Mortal Wkly Rep 2020;69:699-704. DOI: https://doi.org/10.15585/mmwr.mm6923e1
Wright A, Salazar A, Mirica M, et al. The invisible epidemic: Neglected chronic disease management during COVID-19. J Gen Intern Med 2020;35:2816-7. DOI: https://doi.org/10.1007/s11606-020-06025-4
Behrman P, Fitzgibbon ML, Dulin A, et al. Society of behavioral medicine statement on COVID-19 and rural health. Transl Behav Med 2021;11:625-30. DOI: https://doi.org/10.1093/tbm/ibaa114
Zelner J, Trangucci R, Naraharisetti R, Cao A, Malosh R, Broen K, et al. Racial disparities in coronavirus disease 2019 (COVID-19) mortality are driven by unequal infection risks. Clin Infect Dis 2020;72:e88-95. DOI: https://doi.org/10.1093/cid/ciaa1723
Signorello LB, Hargreaves MK, Blot WJ. The Southern Community Cohort Study: investigating health disparities. J Health Care Poor Underserved 2010;21:s26-37. DOI: https://doi.org/10.1353/hpu.0.0245
Harrell Jr FE. Regression modeling strategies, with applications to linear models, logistic and ordinal regression, and survival analysis. New York: Springer; 2015. DOI: https://doi.org/10.1007/978-3-319-19425-7
Centers for Medicare and Medicaid Services. Medicare Current Beneficiary Survey Summer COVID-19 Data Snapshot. 2020. Available from: https://www.cms.gov/medicare-current-beneficiary-survey-summer-2020-covid-19-data-snapshot
Centers for Medicare and Medicaid Services. Medicare Current Beneficiary Survey Fall 2020 COVID-19 Data Snapshot. 2020. Available from: https://www.cms.gov/medicare-current-beneficiary-survey-fall-2020-covid-19-data-snapshot
Kim D, Lee Y, Thorsness R, Nguyen KH, et al. Racial and ethnic disparities in excess deaths among persons with kidney failure during the COVID-19 pandemic, March-July 2020. Am J Kidney Dis 2021;77:827-9. DOI: https://doi.org/10.1053/j.ajkd.2021.02.003
Rossen LM, Branum AM, Ahmad FB, Sutton P, Anderson RN. Excess deaths associated with COVID-19, by age and race and ethnicity – United States, January 26-October 3, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1522-7. DOI: https://doi.org/10.15585/mmwr.mm6942e2
Faust JS, Lin Z, del Rio C. Comparison of estimated excess deaths in New York City during the COVID-19 and 1918 Influenza pandemics. JAMA Network Open 2020;3:e2017527. DOI: https://doi.org/10.1001/jamanetworkopen.2020.17527
Connor J, Madhavan S, Mokashi M, et al. Health risks and outcomes that disproportionately affect women during the Covid-19 pandemic: A review. Soc Sci Med 2020;266:113364. DOI: https://doi.org/10.1016/j.socscimed.2020.113364
Gausman J, Langer A. Sex and gender disparities in the COVID-19 pandemic. J Womens Health (Larchmt) 2020;29:465-6. DOI: https://doi.org/10.1089/jwh.2020.8472
Kaiser Family Foundation [Internet]. Women’s coverage, access, and affordability: Key findings from the 2017 Kaiser Women’s Health Survey. 2018. Available from: https://www.kff.org/womens-health-policy/issue-brief/womens-coverage-access-and-affordability-key-findings-from-the-2017-kaiser-womens-health-survey/
Kaiser Family Foundation [Internet]. Women’s experiences with health care during the COVID-19 pandemic. Findings from the KFF Women’s Health Survey. 2021. Available from: https://www.kff.org/womens-health-policy/issue-brief/womens-experiences-with-health-care-during-the-covid-19-pandemic-findings-from-the-kff-womens-health-survey/
Tai DBG, Shah A, Doubeni CA, et al. The disproportionate impact of COVID-19 on racial and ethnic minorities in the United States. Clin Infect Dis 2021;72:703-6. DOI: https://doi.org/10.1093/cid/ciaa815
Mackey K, Ayers CK, Kondo KK, et al. Racial and ethnic disparities in COVID-19-related infections, hospitalizations, and deaths: A Systematic review. Ann Intern Med 2021;174-362-73. DOI: https://doi.org/10.7326/M20-6306
Garg S, Kim L, Whitaker M, et al. Hospitalization rates and characteristics of patients hospitalized with laboratory-confirmed coronavirus disease 2019 – COVID-NET, 14 states, March 1-30, 2020. MMWR Morb Mortal Wkly Rep 2020;69:458-64. DOI: https://doi.org/10.15585/mmwr.mm6915e3
Sommers BD, Gawande AA, Baicker K. Health insurance coverage and health – What the recent evidence tells us. N Engl J Med 2017;377:586-93. DOI: https://doi.org/10.1056/NEJMsb1706645
Patt D, Gordan L, Diaz M, et al. Impact of COVID-19 on cancer care: How the pandemic is delaying cancer diagnosis and treatment for American seniors. JCO Clin Cancer Inform 2020;4:1059-71. DOI: https://doi.org/10.1200/CCI.20.00134
Mitchell EP. Declines in cancer screening during COVID-19 pandemic. J Natl Med Assoc 2020;112:563-4. DOI: https://doi.org/10.1016/j.jnma.2020.12.004
Sprague BL, Lowry KP, Miglioretti DL, et al. Changes in mammography utilization by women’s characteristics during the first 5 months of the COVID-19 pandemic. J Natl Cancer Inst 2021;113:1161-7. DOI: https://doi.org/10.1093/jnci/djab045
Demeke HB, Merali S, Marks S, et al. Trends in use of telehealth among health centers during the COVID-19 pandemic – United States, June 26-November 6, 2020. MMWR Morb Mortal Wkly Rep 2021;70:240-4. DOI: https://doi.org/10.15585/mmwr.mm7007a3
Warner MA. Stop doing needless things! Saving Healthcare resources during COVID-19 and beyond. J Gen Intern Med 2020;35:2186-8. DOI: https://doi.org/10.1007/s11606-020-05863-6
Gatto M, Bertuzzo E, Mari L, et al. Spread and dynamics of the COVID-19 epidemic in Italy: Effects of emergency containment measures. Proc Natl Acad Sci USA 2020;117:10484-91. DOI: https://doi.org/10.1073/pnas.2004978117
Commonwealth Fund [Internet]. The impact of COVID-19 on outpatient visits in 2020: Visits Remained stable, despite a late surge in cases. 2020. Available from: https://www.commonwealthfund.org/publications/2021/feb/impact-covid-19-outpatient-visits-2020-visits-stable-despite-late-surge