Associations of Social and Structural Determinants of Health with Forgone Care during the COVID-19 Pandemic in Baltimore, Maryland

项目总结 在2019年冠状病毒(新冠肺炎)大流行期间，卫生系统缺乏准备，导致广泛 医疗保健利用中断。这包括放弃的护理，它的定义是感觉到 需要医疗保健，但没有得到医疗保健。这些干扰加剧了发病率和死亡率 与大流行有关，并对那些在全世界经历不平等的人产生了不成比例的影响 健康的社会和结构决定因素(SDoH)。这既包括社会因素也包括结构性因素 个人和社区水平，如收入、使用公共交通工具和接近医疗保健 服务，这可能会影响大流行期间的医疗保健使用。现有文献关于气候变化的影响 对医疗保健利用的大流行主要描述门诊和医院的趋势。然而，很少有人 研究已经捕捉到了病人报告的放弃的护理。这些研究确实着眼于在 已经评估了国家级数据或使用了方便的抽样方法，这可能会限制 可推广到小型化和经济脆弱的社区。这项研究的目的是进一步 描述新冠肺炎大流行期间放弃的护理及其与以下人群中SDoH的关系 居住在马里兰州巴尔的摩的成年人样本。申请人将使用以下工具进行二次数据分析 来自社区合作打击新冠肺炎(C-Forward)和COVID的组合分析数据集- 19预防网络5002(CoVPN)研究。这些研究中的每一项都是单独使用的，但都是免费的 将有助于提高巴尔的摩人口代表性的抽样战略。C-Forward研究 采用人口代表性抽样策略，由人口普查区组组织。CoVPN研究 使用基于场地的抽样，对位于年收入较低和服务不足地区的场地进行过度抽样 巴尔的摩。这项子研究将使用在每个家长研究中完成的关于放弃护理的问题。 其目的是：目标1：描述新冠肺炎期间巴尔的摩放弃护理的流行率 通过横断面分析的组合分析样本的个人水平因素大流行 CoVPN和C-Forward参与者。目标2：检查个人和社区的相对重要性 使SDoH与放弃护理的几率持平。目标3：在探索性分析中，比较放弃的预测因素 具有放弃慢性和预防性护理的预测因素的紧急护理。了解总体流行率 新冠肺炎大流行期间放弃的护理及其与SDOH的交叉点对于提供 全面了解这一流行病对健康的影响，并为制定护理模式提供信息 可以在新冠肺炎和未来的公共卫生紧急情况下利用这一点来维护个人和 社区卫生。建议的论文研究和培训计划直接与NINR的使命相一致 解决卫生不平等和SDOH问题，特别是在突发公共卫生事件的背景下。

PROJECT SUMMARY Lack of health system readiness during the Coronavirus 2019 (COVID-19) pandemic has led to widespread disruptions in healthcare utilization. This includes forgone care, which is defined as someone who perceives a need for healthcare but does not receive it. These disruptions have exacerbated the morbidity and mortality associated with the pandemic and have disproportionately impacted those who experience inequities across the social and structural determinants of health (SDoH). This includes social and structural factors at both the individual and community levels, such as income, access to public transportation, and proximity to healthcare services, that may influence healthcare use during the pandemic. Existing literature on the impacts of the pandemic on healthcare utilization predominately describe outpatient and hospital trends. However, very few studies have captured patient-reported forgone care. Those studies that do look at forgone care during the pandemic have evaluated national-level data or used convenience sampling methods, which may limit generalizability to minoritized and economically vulnerable communities. The purpose of this study is to further describe forgone care during the COVID-19 pandemic and its associations with the SDoH among a sample of adults living in Baltimore, Maryland. The applicant will conduct a secondary data analysis using a combined analytic dataset from the Community Collaborative to Combat COVID-19 (C-Forward) and COVID- 19 Prevention Network 5002 (CoVPN) studies. Each of these studies used separate, yet complimentary sampling strategies that will help improve representativeness of the Baltimore population. The C-Forward study uses a population representative sampling strategy, organized by census block groups. The CoVPN study used venue-based sampling, with oversampling of venues located in lower-income and underserved areas of Baltimore. This sub-study will use questions on forgone care completed on enrollment in each parent study. The aims are to: Aim 1: To characterize the prevalence of forgone care in Baltimore during the COVID-19 pandemic by individual-level factors through a cross-sectional analysis of a combined analytic sample of CoVPN and C-Forward participants. Aim 2: To examine the relative importance of individual and community level SDoH with the odds of forgone care. Aim 3: In an exploratory analysis, compare the predictors of forgone emergency care with predictors of forgone chronic and preventive care. Understanding the overall prevalence of forgone care during the COVID-19 pandemic and its intersections with the SDoH is critical to providing a comprehensive view of the health impacts of the pandemic and informing the development of models of care that can be leveraged during COVID-19 and future public health emergencies to maintain individual and community health. The proposed dissertation study and training plan directly align with the NINR’s mission to address health inequities and the SDoH, specifically within the context of public health emergencies.