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Missed and Delayed Preventive Health Care Visits Among US Children Due to the COVID-19 Pandemic
Lydie A Lebrun-Harris1, Olivia R Sappenfield2, Michael D Warren1
1Maternal and Child Health Bureau, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, MD, USA.
Insights
The COVID-19 pandemic caused over a quarter of US households to miss or delay children's preventive care visits. Disparities were noted, particularly among families facing material hardships, highlighting the need for targeted interventions.
Area of Science:
- Pediatrics
- Public Health
- Health Services Research
Background:
- The COVID-19 pandemic significantly disrupted routine healthcare, including essential preventive services for children in the United States.
- By the close of 2020, a full recovery in pediatric preventive care utilization had not been observed.
Purpose of the Study:
- To estimate the prevalence of missed, skipped, or delayed child preventive checkups in the 12 months preceding the survey due to the pandemic.
- To identify sociodemographic factors associated with these missed visits.
- To understand the primary reasons cited by households for not attending preventive appointments.
Main Methods:
- Utilized data from the US Census Bureau's Household Pulse Survey, Phase 3.1 (April-May 2021).
- Analyzed a sample of 48,824 households with children under 18 years.
- Calculated national and state-level prevalence rates and performed regression analyses to examine associations with household characteristics.
Main Results:
- Nationally, 26.4% of households reported a missed or delayed preventive visit for a child due to COVID-19.
- State-level prevalence ranged from 17.9% in Wyoming to 37.0% in Vermont.
- Missed visits were more common in households experiencing material hardships and were often attributed to concerns about healthcare settings, appointment availability, or clinic closures.
Conclusions:
- The pandemic exacerbated existing inequities in children's access to preventive care.
- Policy and program interventions should prioritize addressing social determinants of health to mitigate these disparities.
- Targeted strategies are needed to ensure continuity of essential pediatric preventive services.
Objective:
The COVID-19 pandemic led to a substantial drop in US children's preventive care, which had not fully rebounded by the end of 2020. We sought to estimate the overall prevalence of missed, skipped, or delayed preventive checkups among households with children in the last 12 months because of the pandemic.
Methods:
We used data from the US Census Bureau's Household Pulse Survey, Phase 3.1 (collected April-May 2021). The analytic sample included 48 824 households with ≥1 child or adolescent aged <18 years. We estimated both national and state-level prevalences, examined associations with sociodemographic and household characteristics, and described reasons for missed or delayed preventive visits.
Results:
Overall, 26.4% (95% CI, 25.5%-27.2%) of households reported that ≥1 child or adolescent had missed or delayed a preventive visit because of COVID-19; percentages varied by state, from 17.9% in Wyoming to 37.0% in Vermont. The prevalence of missed or delayed preventive visits was significantly higher among respondents who reported material hardships (ie, not caught up on rent/mortgage, difficulty paying usual household expenses, children not eating enough because of lack of affordability) than among respondents who did not report material hardships. The most common reasons for missing or delaying preventive visits were concern about visiting a health care provider, limited appointment availability, and the provider's location being closed.
Conclusions:
Programs and policies could reduce gaps in children's preventive care caused by the pandemic, with a particular focus on addressing social determinants of health.
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