DISPARITIES IN HEALTHCARE UTILIZATION BEFORE, DURING, AND AFTER THE COVID-19 PANDEMIC LOCKDOWN

ABSTRACT

Introduction: In response to the coronavirus disease 2019 (COVID-19) pandemic, hospitals nationwide opted to temporarily replace traditional in-person visits with telehealth visits. Unfortunately, due to socio-economic disparities, some groups may be at a disadvantage as a result of these changes. This observational study aimed to determine the temporal trends in demographic, socio-economic, and educational factors contributing to the disparities in access to health care during and after the lockdown. Methods: Due to the COVID-19 pandemic, a state of emergency was declared in Ohio between March 9th, 2020 and June 18th, 2020. The study cohort consisted of patients receiving outpatient care in the Cleveland Clinic Gastroenterology department during this period. To assess disparities, this group was compared to patients receiving care during the corresponding time periods in 2019 and 2021. The following variables were collected and compared between the three groups demographics, substance abuse, education status, household income, insurance data, employment status, and type of visit (in person, virtual, or telephone). Chi-square test was used to compare categorical variables and student's t-test for continuous variables. A p value of <0.05 was considered statistically significant. SPSS software was used. Results: There were a total of 66,796 visits scheduled during the three study periods of which 19,764 patients had multiple visits. Only the first visit was considered for study purposes, thus yielding 47,032 visits. The mean age was 56.3 ± 17.6 years of which 36.9% were ³ 65 years. The cohort was predominantly female (61.9%), white (76.4%), and had private insurance (61.7%). The characteristics of patients seen in 2019, 2020, and 2021 are presented in table 1. Patients age ≥65 years, whites, those with Medicare insurance, non-English speakers and retired individuals sought healthcare less frequently during and after the pandemic. Women utilized healthcare more often than men before, during, and after the pandemic. There were also variations depending upon education level and median house hold income (table 1). The number of in-person visits rapidly declined during the pandemic, yet have not returned to pre-pandemic levels in 2021. The number of no shows/cancelled visits and tobacco, alcohol, and illicit drug use have steadily increased during and after the pandemic. Conclusion: There was reduced utilization of healthcare services during the COVID-19 pandemic among elderly, non-English speaking, retired, and less educated individuals;these negative effects persisted for elderly and non-English speaking individuals even after the lockdown was lifted. The continued increase in no show/cancellation rates and substance abuse is an alarming trend. Therefore, efforts should be targeted on improving healthcare access for these vulnerable groups.