Indirect impact of the COVID-19 pandemic and its containment measures on social inequalities in hospital utilisation in Italy

Abstract

BackgroundThe pandemic may undermine the equity of access to and utilisation of health services for conditions other than COVID-19. The objective of the study is to evaluate the indirect impact of COVID-19 and lockdown measures on sociodemographic inequalities in healthcare utilisation in seven Italian areas.MethodsIn this multicentre retrospective study, we evaluated whether COVID-19 modified the association between educational level or deprivation and indicators of hospital utilisation and quality of care. We also assessed variations in gradients by sex and age class. We estimated age-standardised rates and prevalence and their relative per cent changes comparing pandemic (2020) and pre-pandemic (2018–2019) periods, and the Relative Index of Inequalities (RIIs) fitting multivariable Poisson models with an interaction between socioeconomic position and period.ResultsCompared with 2018–2019, hospital utilisation and, to a lesser extent, timeliness of procedures indicators fell during the first months of 2020. Larger declines were registered among women, the elderly and the low educated resulting in a shrinkage (or widening if RII <1) of the educational gradients for most of the indicators. Timeliness of procedures indicators did not show any educational gradient neither before nor during the pandemic. Inequalities by deprivation were nuanced and did not substantially change in 2020.ConclusionsThe socially patterned reduction of hospital utilisation may lead to a potential exacerbation of health inequalities among groups who were already vulnerable before the pandemic. The healthcare service can contribute to contrast health disparities worsened by COVID-19 through more efficient communication and locally appropriate interventions.

Evaluation of the impact of the COVID-19 pandemic on health service utilization in China: A study using auto-regressive integrated moving average model

“…( 9 ) Another study in Yemen reported a 10% reduction in surgery and a 4% decrease in medical consultation during the early phase of the pandemic in 2020 ( 16 ). Similar trends were observed in other countries, such as Armenia ( 17 ), Iran ( 18 ), and Italy ( 19 ). However, the magnitude and duration of the declines varied across countries and healthcare sectors, reflecting differences in the pandemic’s severity, public health response, healthcare system capacity, and patient behavior.…”

Equity in the recovery of elective and oncological surgery volumes after the COVID-19 lockdown: a multicentre cohort study in Italy

“…Across all the indicators analysed, the most vulnerable strata of the population experienced the greatest contractions and the most modest resumption to pre-pandemic levels. In a previous paper, we reported that during the first seven months of the pandemic, the social gradient in hospital access and volumes, including the surgical ones, became steeper compared to the 2018-19 period [2]. Adding to what was already a worrisome finding, the present study highlights not only that inequalities persist, but also that the pace of recovery has been slower throughout 2021 among the less educated.…”

“…Since the inception of the COVID-19 pandemic, almost 26 000 000 cases have been recorded and more than 190 000 deaths have occurred in Italy [1]. Besides its effects on people's health, the pandemic has had, and still has, a profound impact on the national health system, altering trajectories of care and exacerbating existing inequalities in health [2]. Postponement of surgeries and cancellation of elective surgical procedures were public health early responses to mitigate the spread of the infection in patients and health care professionals [3].…”

“…Postponement of surgeries and cancellation of elective surgical procedures were public health early responses to mitigate the spread of the infection in patients and health care professionals [3]. In Italy, during the first phases of the pandemic, elective surgeries, such as hip and knee replacement, plunged dramatically [4] and people in low socioeconomic positions were more affected by the cut in surgical volumes [2].…”

Social and clinical vulnerability in stroke and STEMI management during the COVID-19 pandemic: a registry-based study

“…To our knowledge, only one study has evaluated whether COVID-19 modified the associations among the educational level, deprivation, hospital admission indicators and quality of hospital care, especially for patients with neurocardiovascular diseases 22. The researchers found larger declines in the hospital access of women, elderly and less-educated individuals; in contrast, the timeliness of percutaneous coronary intervention (PCI) showed no education-related or deprivation-related gradient.…”