Health Care and Social Service Utilization Before, During, and After the COVID-19 Pandemic: An Integrated Data...

The COVID-19 pandemic disrupted health care access and exacerbated social needs, but fragmented data limit coordinated responses across health and social systems.

To assess changes in health care and social service utilization before, during, and after the onset of COVID-19 using an integrated data set, and examine whether social service utilization was associated with recovery period health care utilization and mortality.

Retrospective longitudinal study using difference-in-differences analysis.

An integrated health system and local social service agencies in Mecklenburg County, North Carolina.

In total, 28,258 adult patients attending a safety-net community clinic from September 2018 to August 2021 with 3 distinct periods: Baseline/Prepandemic (September 1, 2018-August 31, 2019), Pandemic (September 1, 2019-August 31, 2020), and Recovery (September 1, 2020-August 31, 2021).

Monthly health care utilization (clinic visits, emergency department [ED] visits with hospitalization, ED visits discharged home) and social service utilization (food assistance, housing/shelter, or emergency financial aid).

Clinic visits declined by approximately 30% from January to April 2020 relative to baseline/prepandemic levels, with a 19% reduction in new chronic condition diagnoses, then rebounded by late 2020. ED visits declined early in the Pandemic period but later shifted toward higher acuity: admissions increased from 11.4% during Baseline/Prepandemic to 13.2% during Recovery, while treat-and-release visits remained below baseline/prepandemic. Social service utilization rose steadily from 33.7% during Baseline/Prepandemic to 36.4% during the Pandemic period and 39.3% during Recovery, largely driven by food assistance (32%-37.6%). In adjusted analyses, social service utilization during the Pandemic period was associated with higher odds of clinic visits and lower odds of mortality during Recovery.

Health care utilization initially declined but normalized by 2021, while social service utilization rose and remained elevated, signaling persistent community needs. Integrated data showed these patterns, demonstrating that social services may mitigate adverse outcomes. Findings underscore the importance of sustaining safety nets and integrated data infrastructure to inform resilient public health responses.