ABSTRACT
Introduction: Racial/ethnic disparities in congenital heart disease outcomes are well documented. The impact of COVID-19 on race/ethnicity in access to ambulatory pediatric cardiology care is unknown. Methods: To examine differences in ambulatory care visits by race/ethnicity and whether differences were exacerbated by the COVID pandemic (March 2020), we examined number of visits scheduled (0-18 years old) and visit completion (as scheduled, delayed completion within 6 months, incomplete) by race/ethnicity. We focused on early pandemic, April 2020 (vs April 2019) and later pandemic, July 2020 (vs April 2020), using chi-square and logistic regression. Results: Annual clinic volume fell by 4.5% during the pandemic (18,725 to 17,866). Race/ethnicity shifted slightly towards white compared to non-white minority (NWM) 30% vs 28%, p<0.001. Public insurance was constant at 33%, p=0.83. Telehealth visits accounted for 46% of visits during the pandemic (0.8% pre-pandemic), with different utility by white than NWM patients (49% vs 43%, p<0.001). Visits in April 2020 fell by 57% from April 2019 and percent of visits completed without delay declined from 69% to 39%, p<0.001. Visits in July were similar from 2019 to 2020 but visits completed without delay declined from 71% to 62%, p<0.001. Visit completion rates varied by race/ethnicity (Figure 1), with differences between white vs NWM early in the pandemic (p=0.01). Differences in visit completion rates by race/ethnicity were not significantly different from the year prior (p for interaction=0.74) or from April to July 2020 (p for interaction=0.48). Conclusions: NWM have higher rates of incomplete/delayed visits compared to whites, though the difference was not statistically heightened by the pandemic. Telehealth visits have become a prominent part of ambulatory care, with higher completion rates by white patients. Efforts to reduce lapses in care are needed across demographics to ensure equitable care delivery.