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Healthcare utilization in children across the care continuum during the COVID-19 pandemic
Alan R Schroeder1, Alex Dahlen2, Natasha Purington2
1Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, United States of America.
Insights
Pediatric healthcare utilization significantly decreased during the COVID-19 pandemic, with fewer infections but a notable rise in mental health hospitalizations. These findings inform future pandemic healthcare strategies for children.
Area of Science:
- Pediatric healthcare utilization
- Public health
- Epidemiology
Background:
- The COVID-19 pandemic profoundly impacted healthcare access and utilization globally.
- Understanding shifts in pediatric healthcare utilization is crucial for public health monitoring and planning.
- Previous studies often focused on specific healthcare settings, limiting a comprehensive view of pediatric care during the pandemic.
Purpose of the Study:
- To compare healthcare utilization, prescription patterns, and diagnosis trends in children across the entire care continuum during the first year of the COVID-19 pandemic versus preceding years.
- To analyze changes in pediatric healthcare utilization during the early and middle phases of the pandemic.
Main Methods:
- Utilized national claims data for enrollees under 18 years.
- Compared data from the pre-pandemic period (January 2016 - mid-March 2020) with the pandemic period (mid-March 2020 - March 2021).
- Employed interrupted time series analysis to compare utilization trends, dividing the pandemic into early and middle phases.
Main Results:
- Overall pediatric healthcare utilization decreased across all settings during the early pandemic, with urgent care visits declining by 76.9%.
- Well visits returned to pre-pandemic rates by the mid-pandemic period.
- Hospitalizations decreased by 43% early in the pandemic and remained 26.6% lower mid-pandemic, while hospitalizations for mental health disorders in non-psychiatric facilities significantly increased mid-pandemic.
Conclusions:
- Healthcare utilization in children experienced a substantial decline during the first year of the pandemic, marked by a decrease in infectious disease-related care and an increase in mental health hospitalizations.
- These findings are vital for monitoring child health, informing healthcare strategies for future pandemics, and identifying potential training needs for pediatric healthcare providers.
- Further research is recommended to investigate the impact of these utilization changes on specific disease incidence and outcomes.
Objectives:
Healthcare utilization decreased during the COVID-19 pandemic, likely due to reduced transmission of infections and healthcare avoidance. Though various investigations have described these changing patterns in children, most have analyzed specific care settings. We compared healthcare utilization, prescriptions, and diagnosis patterns in children across the care continuum during the first year of the pandemic with preceding years.
Study Design:
Using national claims data, we compared enrollees under 18 years during the pre-pandemic (January 2016 -mid-March 2020) and pandemic (mid-March 2020 through March 2021) periods. The pandemic was further divided into early (mid-March through mid-June 2020) and middle (mid-June 2020 through March 2021) periods. Utilization was compared using interrupted time series.
Results:
The mean number of pediatric enrollees/month was 2,519,755 in the pre-pandemic and 2,428,912 in the pandemic period. Utilization decreased across all settings in the early pandemic, with the greatest decrease (76.9%, 95% confidence interval [CI] 72.6-80.5%) seen for urgent care visits. Only well visits returned to pre-pandemic rates during the mid-pandemic. Hospitalizations decreased by 43% (95% CI 37.4-48.1) during the early pandemic and were still 26.6% (17.7-34.6) lower mid-pandemic. However, hospitalizations in non-psychiatric facilities for various mental health disorders increased substantially mid-pandemic.
Conclusion:
Healthcare utilization in children dropped substantially during the first year of the pandemic, with a shift away from infectious diseases and a spike in mental health hospitalizations. These findings are important to characterize as we monitor the health of children, can be used to inform healthcare strategies during subsequent COVID-19 surges and/or future pandemics, and may help identify training gaps for pediatric trainees. Subsequent investigations should examine how changes in healthcare utilization impacted the incidence and outcomes of specific diseases.
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