Health Care Access and Use Among Adults with Diabetes During the COVID-19 Pandemic — United States, February–March 2021

Czeisler, Mark É; Barrett, Chris; Siegel, Karen R.; Weaver, Matthew D.; Czeisler, Charles A.; Rajaratnam, Shantha M W; Howard, Mark; Bullard, Kai McKeever

doi:10.15585/mmwr.mm7046a2

Cited by 32 publications

(29 citation statements)

References 10 publications

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“…Serious adverse consequences accompanied by COVID-19 restrictions are reported in the field of health management. Inaccessible health care among adults with diabetes during the COVID-19 pandemic was documented in the United States [ 73 ]. COVID-19 lockdowns lead to declines in health care utilization.…”

Section: Discussionmentioning

confidence: 99%

Associations between new health conditions and healthcare service utilizations among older adults in the United Kingdom: effects of COVID-19 risks, worse financial situation, and lowered income

Han

Guan

2022

BMC Geriatr

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Background Health services are critically important for older adults, particularly during the Coronavirus disease-19 (COVID-19) pandemic. However, COVID-19 risks, worse financial situation, and lowered income may seriously impact health services by feasibility and accessibility. Therefore, the aim of the present study was empirically to explore how health-seeking behaviors are influenced by new health conditions through COVID-19 risks, worse financial situation, and lowered income. Methods Data were from ELSA COVID-19 waves 1 and 2 which included a sample of 6952 and 6710 older adults in the United Kingdom, respectively. The frequency distribution analyses were conducted by Chi-square analysis by gender groups. Zero-inflated Poisson regressions were used to examine how worse financial situation and lowered income were associated with COVID-19 risks and new health conditions. Logistic regressions were employed to examine the associations of COVID-19 risks, worse financial situation, and lowered income with treatment cancellation and accessible care. Cross-sectional mediation models, cross-sectional moderation models, longitudinal mediation models, and longitudinal moderation models were conducted based on Hayes model 6, Hayes model 29, Montoya model 1, and Montoya model 2, respectively. Results Most of the sample was >65 years old, females, located in urban place, and involved in long-standing condition. Regression analysis showed that COVID-19 risks, worse financial situation, and lowered income were associated with treatment cancellation and accessible care. In the longitudinal mediations, effect coefficients of ‘X’ → (treatment cancellation in wave 1 (Tcn1)- treatment cancellation in wave 2 (Tcn2))(β = −.0451, p < .0001, low limit confidence interval (LLCI) = −.0618, upper limit confidence interval (ULCI) = −.0284), ‘X’ → (COVID-19 risks in wave 1 (Csk1)- COVID-19 risks in wave 2 (Csk2)) (β = .0592, p < .0001, LLCI = .0361, ULCI = .0824), and ‘X’ → (lowered income in wave 1 (CIn1)- lowered income in wave 2 (CIn2)) (β = −.0351, p = .0001, LLCI = -.0523, ULCI = -.0179) were significant. Additionally, effect coefficients of ‘X’ → (accessible care in wave 1 (Acr1)- accessible care in wave 2 (Acr2)) (β = .3687, p < .0001, LLCI = .3350, ULCI = .4025),'X’ → (Csk1- Csk2) (β = .0676, p = .0005, LLCI = .0294, ULCI = .1058), and ‘X’ → (worse financial situation in wave 1- worse financial situation in wave 2) (β = −.0369, p = .0102, LLCI = -.0650, ULCI = -.0087) were significant. Conclusions There were longitudinal mediating effects of COVID-19 risks, worse financial situation, and lowered income on the relationship between new health conditions and treatment cancellation and relationship between new health conditions and accessible care. These findings suggest that worse financial situation, lowered income, and COVID-19 risks exerted an influence on the relationship between new health conditions and treatment cancellation and relationship between new health conditions and accessible care among older adults. Findings suggest that longitudinal mediations may be important components of interventions aiming to meet service needs. Long-term health policy implications indicate the need for reducing COVID-19 risks, improving financial situation, and increasing income among the targeted population.

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Section: Discussionmentioning

confidence: 99%

Associations between new health conditions and healthcare service utilizations among older adults in the United Kingdom: effects of COVID-19 risks, worse financial situation, and lowered income

Han

Guan

2022

BMC Geriatr

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“…Secondary covariates included demographic characteristics of the participants, based on the literature review, to control for potential confounders, including sex, education, employment status, health insurance, smoking status, and rural–urban classification [ 8 , 16 , 36 , 37 ]. Sex was a binary variable, and age was a categorical variable: 18–24, 25–44, 45–64, 65–84, and 85 or above.…”

Section: Methodsmentioning

confidence: 99%

“…Research conducted in the USA showed widespread feelings of anxiety and depression more than doubled during the pandemic [ 11 , 15 ]. Mental health problems in the presence of preexisting comorbidities, such as diabetes, were even further compounded by a lack of necessary healthcare access due to diminished service provision by providers or individuals’ disinclination to visit doctors in person [ 16 , 17 ]. Moreover, systematic reviews suggested a link between COVID-19 and increased prevalence of post-traumatic stress disorder (PTSD) [ 14 , 18 ], which can develop as a result of traumatic events related to natural disasters and accidents, for example, Hurricane Katrina in LA [ 19 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

Increased Self-Reported Mental Health Problems Among Asian-Americans During the COVID-19 Pandemic in the United States: Evidence from a Nationally Representative Database

Lee

Howard

2022

J. Racial and Ethnic Health Disparities

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Background To investigate changes in mental health outcomes among racial groups between 2019 and 2020. Methods A retrospective cohort study was conducted using the third through fourth quarters of 2019–2020 longitudinal data from the National Health Interview Survey. Self-reports of diagnosed depression and anxiety disorder were key outcomes. We calculated the percentage of depression and anxiety disorder across baseline sample characteristics. Discrete-time hazard models stratified by race/ethnicity were conducted, with hazard ratios (HRs), 95% confidence intervals (CIs), and p -values reported. Results Of a total 10,415 individuals, 16.3 and 14.1% reported that they were diagnosed with depression and anxiety disorder in 2019, respectively. In the multivariable model, only Asian-Americans experienced a significant increase in the probability of receiving a diagnosis of depression by 104% between 2019 and 2020 (HR 2.04, 95%CI 1.19–3.52; p = 0.010). Also, Asian-Americans had a 97% (HR 1.97, 95%CI 1.23–3.15; p = 0.005) greater probability of being diagnosed with anxiety disorder in 2020 than in the previous year, while Hispanics and Whites had a relatively moderate increase of 40% (HR 1.40, 95%CI 1.01–1.76; p = 0.040) and 11% (HR 1.11, 95%CI 1.03–1.20; p = 0.007), respectively. Conclusions Asian-Americans experienced a disproportionate increase in mental health conditions during the COVID-19 pandemic. Discriminatory behaviors against Asian-Americans may be important contributors. The study findings suggest the need for serious actions to address this issue.

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“…During the highest intensity periods of COVID-19 transmission, elective surgeries were routinely cancelled and waiting times were increased in order to conserve beds [ 2 , 3 , 4 ], and routine clinic visits such as those for vaccination [ 5 ], cancer screenings [ 6 , 7 , 8 ], and sexually transmitted disease testing [ 9 ] were often foregone [ 10 ]. In fact, the fear of contracting COVID-19 dissuaded many from even presenting to health care establishments [ 11 , 12 ], leading to breaks in the continuity of patient care, decreased preventive medicine, and delayed diagnosis and management of otherwise treatable medical conditions [ 13 ]. These collateral effects of the pandemic are often measured using excess deaths, which have been higher-than-expected in multi-country analyses attempting to quantify the unseen impacts of COVID-19 [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Changes in Health Care Access during the COVID-19 Pandemic: Estimates of National Japanese Data, June 2020–October 2021

Tanoue

Ghaznavi

Kawashima

et al. 2022

IJERPH

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The COVID-19 pandemic has disrupted health care access around the world, both for inpatients and outpatients. We applied a quasi-Poisson regression to national, monthly data on the number of outpatients, number of inpatients, length of average hospital stay, and the number of new hospitalizations from March 2015 to October 2021 to assess how these outcomes changed between June 2020 to October 2021. The number of outpatient visits were lower-than-predicted during the early phases of the pandemic but normalized by the fall of 2021. The number of inpatients and new hospitalizations were lower-than-predicted throughout the pandemic, and deficits in reporting continued to be observed in late 2021. The length of hospital stays was within the predicted range for all beds, but when stratified by bed type, was higher than predicted for psychiatric beds, lower-than-predicted for tuberculosis beds, and showed variable changes in long-term care insurance beds. Health care access in Japan was impacted by the COVID-19 pandemic.

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Health Care Access and Use Among Adults with Diabetes During the COVID-19 Pandemic — United States, February–March 2021

Cited by 32 publications

References 10 publications

Associations between new health conditions and healthcare service utilizations among older adults in the United Kingdom: effects of COVID-19 risks, worse financial situation, and lowered income

Associations between new health conditions and healthcare service utilizations among older adults in the United Kingdom: effects of COVID-19 risks, worse financial situation, and lowered income

Increased Self-Reported Mental Health Problems Among Asian-Americans During the COVID-19 Pandemic in the United States: Evidence from a Nationally Representative Database

Changes in Health Care Access during the COVID-19 Pandemic: Estimates of National Japanese Data, June 2020–October 2021

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