摘要：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 lowincome individuals in 12 southeastern states from 2002-2009. COVID survey data were combined with baseline and follow-up data.
Results: Among 4463 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.
Significance for public health
Lapses in routine medical care for chronic conditions and preventative healthcare due to the COVID-19 pandemic may have long-term adverse public health effects. These effects may be exacerbated among low-income individuals in the southeastern US who already experience higher rates of chronic disease and poor health outcomes. This study finds that the main drivers of healthcare lapses during the pandemic originate from the healthcare system through provider-initiated cancellations and from individual perceptions regarding the risk of contracting and surviving COVID-19, rather than medical comorbidities. The findings further identify a need for outreach efforts to re-engage patients in chronic and preventative care, as well as characteristics of groups that will benefit from targeted population-based interventions, including women.
关键词：Key wordsenHealthcare disruptionCOVID-19Preventative careLow income
