Gender disparities in access to care for time-sensitive conditions during COVID-19 pandemic in Chile

Abstract

Background During the COVID-19 pandemic, reductions in healthcare utilization are reported in different contexts. Nevertheless, studies have not explored specifically gender disparities in access to healthcare in the context of COVID-19. Methods To evaluate gender disparities in access to medical in Chile we conducted an interrupted time series analysis using segmented regression. The outcome variable was the number of weekly confirmed cases of a set of oncologic and cardiovascular time-sensitive conditions at a national level. The series contained data from weeks 1 to 39 for 2017 to 2020. The intervention period started at week 12. We selected this period because preventive interventions, such as school closures or teleworking, were implemented at this point. We estimated the level effect using a dummy variable indicating the intervention period and slope effect using a continuous variable from weeks 12 to 39. To test heterogeneity by gender and age group, we conducted a stratified analysis. Results We observed a sizable reduction in access to care with a slowly recovery for oncologic (level effect 0.323; 95% CI 0.291–0.359; slope effect 1.022; 95% CI 1.016–1.028) and cardiovascular diseases (level effect 0.586; 95% CI 0.564–0.609; slope effect 1.009; 95% CI 1.007–1.011). Greater reduction occurred in women compared to men, particularly marked on myocardial infarction (level effect 0.595; 95% CI 0.566–0.627 versus 0.532; 95% CI 0.502–0.564) and colorectal cancer (level effect 0.295; 95% CI 0.248–0.35 versus 0.19; 95% CI 0.159–0.228). Compared to men, a greater absolute reduction was observed in women for oncologic diseases, excluding sex-specific cancer, (1352; 95% CI 743–1961) and cardiovascular diseases (1268; 95% CI 946–1590). Conclusion We confirmed a large drop in new diagnoses for time-sensitive conditions during the COVID-19 pandemic in Chile. This reduction was greater for women. Our findings should alert policy-makers about the urgent need to integrate a gender perspective into the pandemic response.

Impact of the COVID-19 Pandemic on Cardiovascular Health in 2020

“… 17 New stroke and myocardial infarction diagnoses decreased by 9,047 cases in men and 10,315 cases in women in Chile. 19 In Italy, the Lazio and Rome region saw almost a 70% decline in ST-segment elevation myocardial infarction admissions, and the Bologna region saw a 58% decline in CVD-related emergency department visits, with a 10% decline in CVD admissions. 20 , 21 In Austria, the Styria region saw the likelihood of an admission for MI decline by a quarter.…”

Gender Differences in Admissions and In-Hospital Outcomes of Patients With Acute Coronary Syndromes During the Coronavirus Disease 2019 Pandemic

“…De Rosa et al [ 3 ] in Italy found a higher reduction for females admitted with STEMI (41.2%; p = 0.011) than males (17.8%; p = 0.191). Further, Pacheco et al [ 19 ] documented a greater reduction in females compared to males of myocardial infarction admissions (level effect = 0.595 (0.566-0.627) versus 0.532 (0.502-0.564)).…”

“…Few studies have been conducted to investigate the gender differences in patients hospitalized with ACS during the COVID-19 pandemic with divergent results regarding the admission frequency, invasive procedures, and outcomes [ 3 , 17 - 19 ]. Therefore, we undertook this study to investigate the gender differences in hospitalizations and in-hospital outcomes of patients with ACS during the COVID-19 pandemic.…”

Chronic disease relapses: A cross-sectional study of the associated factors and socioeconomic inequalities during the COVID-19 pandemic in Peru

“…Indeed, it has been shown that women are more likely to be diagnosed and receive care for non-communicable diseases due to a greater awareness of the signs and symptoms of these diseases and, consequently, an increase in seeking care in health centers [25]. However, barriers in access to health services have been accentuated with the pandemic, such as having less free time due to family responsibilities, a reduction in the ability to pay for health care due to shorter work hours, higher unemployment, decreased economic income, and the fear of being infected by COVID-19 [26]. In this way, the delay in the care of patients with chronic diseases may affect the probability of presenting CDR.…”