Chronic Illness and Delayed or Missed Health Care during the Covid-19 Pandemic (2020-2022)

Background/Purpose: The Covid-19 pandemic disrupted the US healthcare system in numerous ways. Data from the Census Household Pulse Survey and the RANDS series of surveys show that delayed and missed medical care increased in 2020 over previous years (CDC, 2021). Early evidence suggests that these delays in care were disproportionately experienced by BIPOC communities (Ponce et al., 2023) and those with physical and mental limitations of any type were also more likely to experience delays in care (Akobrshoev et al., 2022). Research has also shown that there are several chronic health conditions that heighten the risk of severe Covid-19 complications and require ongoing medical care (Yek et al., 2022). This additional Covid-19 risk heightens concerns that those most at risk from both current chronic illness AND Covid-19 might miss out on lifesaving and life-extending medical care. This paper analyzed disparities in delayed and missed health care due to the Covid-19 pandemic among those with high-risk chronic illnesses (immunosuppression, diabetes, and cardiovascular disease) and how any patterns in delayed and missed care by chronic illness changed over the course of the pandemic (2020-2022).

Method: We use the 2020-2022 waves of the 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, whether disparities in care exist by race/ethnicity, income and health insurance status, and how any disparities in care changed over the course of the pandemic (NCHS, 2023). 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. While rates of delayed and missed care decreased in 2021 and 2022, these disparities remained. 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. 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. 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 telehealth likely need to be more accessible to those with very low incomes.