(see Poster Gallery) Social Determinants of Health Care Delays during the COVID-19 Pandemic Among Racial and Ethnic Minority Older Adults in the United States

Background and Purpose

Disruptions in health care access and treatment delays have been observed during the COVID-19 pandemic. Health care delays are especially prevalent among older adults, which can have lasting implications on their health. Moreover, there is a growing concern that reduced access to health care may be falling heavily on people of color given that they have disproportionately experienced financial difficulty and loss of insurance coverage during the pandemic. Yet, little is known about the specific factors contributing to delayed access to health care services in racial and ethnic minority groups. Guided by Andersen’s Behavioral Model of Health Services Use, this study aims to identify the social determinants of health care delays using a nationally representative sample of racial and ethnic minority older adults in the United States.

Methods

This study used a cross-sectional research design. Data for this study were drawn from the 2020 COVID-19 mail survey of the National Health Aging Trend Study (NHATS), which included Medicare enrollees aged 65 and older in the United States. A subsample of older adults from racial and ethnic minority groups (i.e., African American, Hispanic, Native American, Asian, and Native Hawaiian) were selected for the current analysis (N = 204). Health care delays were measured using an index of 11 health care services that the participants put off during the pandemic, including seeing the usual doctor, seeing a specialist, having surgery, physical therapy, and emergency care. Multiple linear regression models were estimated to examine the predisposing (i.e., age, gender), enabling (i.e., Medicaid coverage, experiencing financial difficulties due to the pandemic), and needs (i.e., depressive symptoms and anxiety, tested positive for COVID, and living in a care facility) factors as potential correlates of health care delays.

Results

Results indicated that age was a predictor of health care delays, with older people delaying more health care services or treatments compared to their younger counterparts (B = .03, p = .043). Moreover, financial status—specifically, experiencing financial difficulties because of the pandemic—was tied to delaying more health care services than not experiencing financial difficulties (B = .56, p = .027).

Conclusions and Implications

This study focuses on racial and ethnic minority older adults, populations that are vulnerable to not only the coronavirus but also the indirect effect of the COVID-19 pandemic—delays in health care access. The findings of the study revealed the risk factors for health care delays, which can help social workers better identify at-risk populations and connect them with resources. Moreover, this study sheds light on the heterogeneity in racial and ethnic minority older adults by identifying individual differences in delaying access to health care services. These findings are critically important for the development of tailored strategies to mitigate collateral effects of the pandemic. Future research can focus on a specific racial/ethnic minority group and examine how its unique contextual factors influence health care delays among older adults within this group.