An evaluation of the impact of social and structural determinants of health on forgone care during the COVID-19 pandemic in Baltimore, Maryland

• Published in: PloS one Vol. 19; no. 5; p. e0302064
• Main Authors: Meyer, Diane, Lowensen, Kelly, Perrin, Nancy, Moore, Ayana, Mehta, Shruti H, Himmelfarb, Cheryl R, Inglesby, Thomas V, Jennings, Jacky M, Mueller, Alexandra K, LaRicci, Jessica N, Gallo, Woudase, Bocek, Adam P, Farley, Jason E
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 13.05.2024; Public Library of Science (PLoS)
• Subjects: Adolescent; Adult; Aged; Baltimore - epidemiology; Chronic illnesses; Comorbidity; Computer and Information Sciences; COVID-19; COVID-19 - epidemiology; Cross-Sectional Studies; Data acquisition; Data analysis; Disease prevention; Earth Sciences; Emergency preparedness; Epidemics; Female; Health care; Health care access; Health planning; Health services; Health Services Accessibility; Humans; Information management; Male; Maryland; Medicine and Health Sciences; Mental disorders; Mental illness; Middle Aged; Morbidity; Mortality; Neighborhoods; Pandemics; Patient Acceptance of Health Care - statistics & numerical data; Public health; Research and Analysis Methods; SARS-CoV-2; Social Determinants of Health; Social Sciences; Utilization; Young Adult; Baltimore; Maryland; United States > US; Baltimore Maryland
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0302064

Evidence suggests that reductions in healthcare utilization, including forgone care, during the COVID-19 pandemic may be contributing towards excess morbidity and mortality. The objective of this study was to describe individual and community-level correlates of forgone care during the COVID-19 pandemic. We conducted a cross-sectional, secondary data analysis of participants (n = 2,003) who reported needing healthcare in two population-representative surveys conducted in Baltimore, MD in 2021 and 2021-2022. Abstracted data included the experience of forgone care, socio-demographic data, comorbidities, financial strain, and community of residence. Participant's community of residence were linked with data acquired from the Baltimore Neighborhood Indicators Alliance relevant to healthcare access and utilization, including walkability and internet access, among others. The data were analyzed using weighted random effects logistic regression. Individual-level factors found to be associated with increased odds for forgone care included individuals age 35-49 (compared to 18-34), female sex, experiencing housing insecurity during the pandemic, and the presence of functional limitations and mental illness. Black/African American individuals were found to have reduced odds of forgone care, compared to any other race. No community-level factors were significant in the multilevel analyses. Moving forward, it will be critical that health systems identify ways to address any barriers to care that populations might be experiencing, such as the use of mobile health services or telemedicine platforms. Additionally, public health emergency preparedness planning efforts must account for the unique needs of communities during future crises, to ensure that their health needs can continue to be met. Finally, additional research is needed to better understand how healthcare access and utilization practices have changed during versus before the pandemic.