(Withdrawn) Chronic Illness and Disparities in Health Care Access during the Covid-19 Pandemic

Background/Purpose: The Covid-19 pandemic disrupted the US healthcare system in numerous ways in 2020, and data from the Census Household Pulse Survey and the RANDS series of surveys conducted through the National Center for Health Statistics show that delayed and missed medical care increased in 2020 over previous years (CDC, 2021). Early evidence suggests that these delays in care were distributed evenly across different racial/ethnic and income groups (Geranios, Kagabo, and Kim, 2022), but that those with physical and mental limitations of any type were more likely to experience delays in care—likely due to having higher medical needs than those without limitations. Research has also shown that there are a number of chronic health conditions that heighten the risk of severe Covid-19 complications and that also require ongoing medical care (Yek et al., 2022), and this additional Covid-19 risk heightens concerns that those most at risk from both current chronic illness AND Covid-19 could be missing out on lifesaving and life-extending medical care. This paper will analyze disparities in delayed and missed health care among those with these chronic illnesses (immunosuppression, diabetes, and cardiovascular disease) due to the Covid-19 pandemic.

Method: We use the 2020 National Health Interview Survey, a nationally representative dataset to assess and monitor the health of the US population, to examine if chronic illness is associated with delayed and missed medical care, which chronic diseases had the highest risk of delayed and missed care, and whether disparities in care exist by race/ethnicity, income and health insurance status (NCHS, 2022). We use multivariate logistic regression models to estimate odds ratios of delayed and missed medical care during the onset of the Covid-19 pandemic and limit the sample to those interviewed after the onset of the pandemic between July and December 2020.

Results: Immunosuppressed adults missed the most care during the second half of 2020 compared to those without chronic conditions (OR=2.5), followed by those with diabetes (OR=1.4), and cardiovascular disease (OR=1.4). All odds ratios were statistically significant. Within the immunosuppressed sample, we also found that those living below the poverty line were significantly more likely to delay or miss care than those with higher incomes. We did not find any other patterns by sociodemographic groups.

Conclusion: Adults with chronic health conditions were significantly more likely to delay or miss necessary medical care during the onset of the Covid-19 pandemic than those without chronic health conditions, and these patterns were not distributed evenly across conditions. Adults with immunosuppression were significantly more likely to delay or miss care than those with diabetes and cardiovascular disease, potentially reflecting their higher medical needs requiring frequent interactions with medical providers and/or their concerns about contracting Covid-19 given their higher risk. It is also noteworthy that those living below the poverty line and immunosuppressed were the most likely to miss care, suggesting that outreach efforts including telemedicine likely need to be more accessible to those with very low incomes.