Healthcare disparity among elderly patients with cirrhosis during the COVID pandemic

ABSTRACT

Background and Aim: We aimed to study the healthcare disparity among elderly patients with cirrhosis and its impact on composite outcomes during the COVID pandemic. Methods: We conducted a prospective observational study between July 21- May 2022 via telephonic interview or physical consultations at 2 large tertiary care centers in India. The data was captured using pre-validated questionnaires to assess healthcare disparity amongst elderly patients with cirrhosis. Results: Of 475 elderly (≥65years) patients with cirrhosis (based on imaging) were included with mean age of 72.1years, malefemale(3.81) with aetiology of cirrhosis being NAFL/NASH (58%), alcohol(32%) in majority. 323 (69%) had access to internet, however amongst them only 247 (52%) were conversant with use of WhatsApp, the preferred platform for tele-consultations in most hospitals in India. 147(31%) had walkability and accessibility to hospitals and 223(47%) had access to a family physician or community nurse, 271 (67%) had laboratory access. 295(62%) had taken both Covid vaccines, 349(74%) had first dose alone and only 38(8%) had booster dose. 213 (45%) felt that they needed admission/ expert opinion at least once during the period with 137 (29%) needed inpatient treatment. 266 (56%) missed at least 15 days doses of drugs with 85(32%) citing unavailability and 48(18%) unaffordability. Cancellation/rescheduling of medical services was widely prevalent with 74(15.5%) needing to reschedule endoscopy, 132 (28%) had cancellation of imaging of any form at least once, loco-regional therapy was rescheduled in 14(18%) patients of HCC. Advanced age, presence of >1 co-morbidity, tense ascites, hepatic encephalopathy, lack of caregivers were signi cantly associated with poor quality of life, restricted access and utilization of healthcare Conclusions: Elderly patients with cirrhosis had significant barriers in seeking healthcare during Covid19 pandemic highlighting the disparity and need for concerted e orts to improve their access to care.