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Infant Health Care Disruptions by Race and Ethnicity, Income, and Insurance During the COVID-19 Pandemic
Erica L Eliason1, Jasmine Agostino1, Patrick Vivier2
1Department of Health Services, Policy & Practice (EL Eliason and J Agostino), Brown University School of Public Health, Providence, RI.
Insights
The COVID-19 pandemic disrupted infant healthcare, with higher risks for non-Hispanic Black infants and those with Medicaid or no insurance. These findings highlight critical areas for improving infant health equity in the US.
Area of Science:
- Public Health
- Pediatric Health
- Health Disparities
Background:
- The COVID-19 pandemic significantly disrupted pediatric care, potentially worsening existing health disparities.
- These disruptions have not been adequately explored among infants, a vulnerable population.
Purpose of the Study:
- To evaluate the impact of the COVID-19 pandemic on infant healthcare disruptions.
- To examine these disruptions across different racial and ethnic groups, income levels, and insurance types.
Main Methods:
- A cross-sectional study utilizing the Pregnancy Risk Assessment Monitoring System COVID-19 supplement.
- Data from 29 jurisdictions analyzed infant well visits, virtual appointments, and immunization schedules.
- Multivariable logistic regression assessed associations between disruptions and demographic factors.
Main Results:
- Overall, 7.25% of infants experienced canceled/delayed well visits, 5.49% shifted to virtual appointments, and 5.33% had postponed immunizations.
- Non-Hispanic Black infants and those with uninsured or Medicaid-paid deliveries faced higher odds of visit cancellations/delays and postponed immunizations.
- Hispanic infants and those with Medicaid-paid deliveries had increased odds of virtual appointment adoption.
Conclusions:
- The COVID-19 pandemic disproportionately impacted infant healthcare for specific racial/ethnic and socioeconomic groups.
- Findings underscore the need to address infant health inequities to improve health outcomes.
- Targeted interventions are crucial for mitigating pandemic-related healthcare access barriers for infants.
Objective:
Research has found disruptions in pediatric care during the COVID-19 pandemic, likely exacerbating existing disparities, which has not been explored among infants. This study evaluated how infant health care was disrupted during the COVID-19 pandemic overall and by race and ethnicity, income, and insurance type.
Methods:
This cross-sectional study used the Pregnancy Risk Assessment Monitoring System COVID-19 supplement with data from 29 jurisdictions to examine infant health care disruptions due to the pandemic: 1) well visits/checkups canceled or delayed, 2) well visits/checkups changed to virtual appointments, and 3) postponed immunizations. Unadjusted, weighted proportions of outcomes were calculated overall and by race and ethnicity, income, and insurance. We estimated multivariable odds ratios for the association between infant care disruptions and race and ethnicity, income, and insurance.
Results:
Overall, among 12,053 parental respondents with infants born from April to December 2020, 7.25% reported cancelations or delays in infant well visits/checkups, 5.49% reported changes to virtual infant care appointments, and 5.33% reported postponing immunizations, with significant differences by race and ethnicity, income, and insurance type. In adjusted analyses, we found higher odds of canceling/delaying visits and postponing immunizations among non-Hispanic Black infants and infants whose parents were uninsured or had Medicaid-paid deliveries. The odds of switching to virtual appointments were significantly higher among Hispanic infants and infants whose parents had Medicaid-paid deliveries.
Conclusions:
Study findings suggest that the COVID-19 pandemic particularly affected infant health care for non-Hispanic Black infants and infants whose parents were uninsured or had Medicaid, with important implications for addressing infant health inequities and improving health outcomes in the United States.
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