Reports of Forgone Medical Care Among US Adults During the Initial Phase of the COVID-19 Pandemic.
Reports of Forgone Medical Care Among US Adults During the Initial Phase of the COVID-19 Pandemic.
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DOI：
10.1001/jamanetworkopen.2020.34882
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发表时间：
2021-01-04
影响因子：
13.8
通讯作者：
Barry CL
中科院分区：
文献类型：
--
作者：
Anderson KE;McGinty EE;Presskreischer R;Barry CL
2020 年 3 月至 7 月中旬，即美国 2019 年冠状病毒病 (COVID-19) 大流行的初始阶段，报告放弃医疗服务的频率和原因是什么？在这项对 1337 名参与者进行的全国调查中，41% 的受访者表示从 2020 年 3 月到 7 月中旬放弃了医疗护理。在报告在此期间需要护理的成年人中，超过一半的人表示因任何原因放弃了护理，超过四分之一的人表示由于担心严重急性呼吸综合征冠状病毒 2 传播而放弃了护理，7% 的人表示由于经济问题而放弃了护理。这项调查研究发现，2020 年 3 月至 7 月中旬放弃护理的频率很高，受访者通常将放弃护理的原因归因于 COVID-19 大流行的影响。这项调查研究调查了 COVID-19 大流行期间美国成年人放弃护理的频率和原因。 2019 年冠状病毒病 (COVID-19) 大流行对美国医疗保健系统造成了重大破坏。估计 2020 年 3 月至 7 月中旬报告放弃医疗护理的频率和原因，并检查报告放弃医疗护理的美国成年人的特征。这项调查研究使用了 2020 年 7 月 7 日至 7 月 22 日开展的第二波约翰霍普金斯大学 COVID-19 公民生活和公共卫生调查的数据。受访者包括 1337 名美国 18 岁或以上的个人样本，他们是国家民意研究中心 AmeriSpeak 小组的成员。美国 COVID-19 大流行的初期，定义为 2020 年 3 月至 7 月中旬。主要结果是处方药漏服；放弃预防性和其他一般医疗保健、精神保健和择期手术；放弃对新的严重健康问题的护理；以及放弃护理的原因。在完成约翰·霍普金斯大学 COVID-19 公民生活和公共卫生调查第一波（完成率为 70.4%）的 1,468 人中，有 1,337 人完成了第二波（完成率为 91.1%）。受访者样本包括 691 名 (52%) 女性、840 名非西班牙裔白人 (63%)、160 名非西班牙裔黑人 (12%) 和 223 名西班牙裔 (17%)。受访者的平均 (SE) 年龄为 48 (0.78) 岁。从 2020 年 3 月到 7 月中旬，共有 544 名受访者 (41%) 放弃了医疗护理。在 1055 名报告需要护理的人 (79%) 中，544 名受访者 (52%) 报告因任何原因放弃护理，307 名受访者 (29%) 因担心严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 传播而放弃护理，75 名受访者 (7%) 因相关经济问题放弃护理随着 COVID-19 大流行。与就业受访者相比，失业受访者放弃护理的频率更高（186 名受访者中的 121 名 [65%] vs 503 名受访者中的 251 名 [50%]；P = .01），并且更有可能将放弃护理归因于担心 SARS-CoV-2 传播（186 名受访者中的 78 名 [42%] vs 503 名受访者中的 120 名 [24%]； P = .002）和财务问题（186 名受访者中的 36 名 [20%] vs 503 名受访者中的 28 名 [6%]；P = .001）。与拥有医疗保险或商业保险的受访者相比，缺乏健康保险的受访者更有可能将放弃护理归因于财务问题（88 名受访者中的 19 名 [22%] vs 768 名受访者中的 32 名 [4%]；P < .001）。在某些情况下，放弃护理的频率和原因因种族/民族、社会经济地位、年龄和健康状况而异。这项调查研究发现，从 2020 年 3 月到 7 月中旬，美国成年人放弃护理的频率很高。随着 COVID-19 病例率的飙升，可能有必要制定政策来提高医疗保健负担能力并让个人放心他们可以安全地寻求护理。
What are the frequency of and reasons for reported forgone medical care from March to mid-July 2020, the initial phase of the coronavirus disease 2019 (COVID-19) pandemic in the US? In this national survey of 1337 participants, 41% of respondents reported forgoing medical care from March through mid-July 2020. Among adults who reported needing care during this period, more than half reported forgoing care for any reason, more than one-quarter reported forgoing care owing to fear of severe acute respiratory syndrome coronavirus 2 transmission, and 7% reported forgoing care owing to financial concerns. This survey study found that there was a high frequency of forgone care from March to mid-July 2020, with respondents commonly attributing the causes of forgone care to repercussions of the COVID-19 pandemic. This survey study examines the frequency of and reasons for reported forgone care among US adults during the COVID-19 pandemic. The coronavirus disease 2019 (COVID-19) pandemic has caused major disruptions in the US health care system. To estimate frequency of and reasons for reported forgone medical care from March to mid-July 2020 and examine characteristics of US adults who reported forgoing care. This survey study used data from the second wave of the Johns Hopkins COVID-19 Civic Life and Public Health Survey, fielded from July 7 to July 22, 2020. Respondents included a national sample of 1337 individuals aged 18 years or older in the US who were part of National Opinion Research Center’s AmeriSpeak Panel. The initial period of the COVID-19 pandemic in the US, defined as from March to mid-July 2020. The primary outcomes were missed doses of prescription medications; forgone preventive and other general medical care, mental health care, and elective surgeries; forgone care for new severe health issues; and reasons for forgoing care. Of 1468 individuals who completed wave 1 of the Johns Hopkins COVID-19 Civic Life and Public Health Survey (70.4% completion rate), 1337 completed wave 2 (91.1% completion rate). The sample of respondents included 691 (52%) women, 840 non-Hispanic White individuals (63%), 160 non-Hispanic Black individuals (12%), and 223 Hispanic individuals (17%). The mean (SE) age of respondents was 48 (0.78) years. A total of 544 respondents (41%) forwent medical care from March through mid-July 2020. Among 1055 individuals (79%) who reported needing care, 544 (52%) reported forgoing care for any reason, 307 (29%) forwent care owing to fear of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission, and 75 (7%) forwent care owing to financial concerns associated with the COVID-19 pandemic. Respondents who were unemployed, compared with those who were employed, forwent care more often (121 of 186 respondents [65%] vs 251 of 503 respondents [50%]; P = .01) and were more likely to attribute forgone care to fear of SARS-CoV-2 transmission (78 of 186 respondents [42%] vs 120 of 503 respondents [24%]; P = .002) and financial concerns (36 of 186 respondents [20%] vs 28 of 503 respondents [6%]; P = .001). Respondents lacking health insurance were more likely to attribute forgone care to financial concerns than respondents with Medicare or commercial coverage (19 of 88 respondents [22%] vs 32 of 768 respondents [4%]; P < .001). Frequency of and reasons for forgone care differed in some instances by race/ethnicity, socioeconomic status, age, and health status. This survey study found a high frequency of forgone care among US adults from March to mid-July 2020. Policies to improve health care affordability and to reassure individuals that they can safely seek care may be necessary with surging COVID-19 case rates.