Prevalence and determinants of healthcare avoidance during the COVID-19 pandemic: A population-based cross-sectional study.

<h4>Background</h4>During the Coronavirus Disease 2019 (COVID-19) pandemic, the number of consultations and diagnoses in primary care and referrals to specialist care declined substantially compared to prepandemic levels. Beyond deferral of elective non-COVID-19 care by healthcare provid...

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Autores principales:	Marije J Splinter, Premysl Velek, M Kamran Ikram, Brenda C T Kieboom, Robin P Peeters, Patrick J E Bindels, M Arfan Ikram, Frank J Wolters, Maarten J G Leening, Evelien I T de Schepper, Silvan Licher
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R
Acceso en línea:	https://doaj.org/article/6e49e3b151544a469d4f21b9cf20bb5a
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spelling	oai:doaj.org-article:6e49e3b151544a469d4f21b9cf20bb5a2021-12-02T19:56:00ZPrevalence and determinants of healthcare avoidance during the COVID-19 pandemic: A population-based cross-sectional study.1549-12771549-167610.1371/journal.pmed.1003854https://doaj.org/article/6e49e3b151544a469d4f21b9cf20bb5a2021-11-01T00:00:00Zhttps://doi.org/10.1371/journal.pmed.1003854https://doaj.org/toc/1549-1277https://doaj.org/toc/1549-1676<h4>Background</h4>During the Coronavirus Disease 2019 (COVID-19) pandemic, the number of consultations and diagnoses in primary care and referrals to specialist care declined substantially compared to prepandemic levels. Beyond deferral of elective non-COVID-19 care by healthcare providers, it is unclear to what extent healthcare avoidance by community-dwelling individuals contributed to this decline in routine healthcare utilisation. Moreover, it is uncertain which specific symptoms were left unheeded by patients and which determinants predispose to healthcare avoidance in the general population. In this cross-sectional study, we assessed prevalence of healthcare avoidance during the pandemic from a patient perspective, including symptoms that were left unheeded, as well as determinants of healthcare avoidance.<h4>Methods and findings</h4>On April 20, 2020, a paper COVID-19 survey addressing healthcare utilisation, socioeconomic factors, mental and physical health, medication use, and COVID-19-specific symptoms was sent out to 8,732 participants from the population-based Rotterdam Study (response rate 73%). All questionnaires were returned before July 10, 2020. By hand, prevalence of healthcare avoidance was subsequently verified through free text analysis of medical records of general practitioners. Odds ratios (ORs) for avoidance were determined using logistic regression models, adjusted for age, sex, and history of chronic diseases. We found that 1,142 of 5,656 included participants (20.2%) reported having avoided healthcare. Of those, 414 participants (36.3%) reported symptoms that potentially warranted urgent evaluation, including limb weakness (13.6%), palpitations (10.8%), and chest pain (10.2%). Determinants related to avoidance were older age (adjusted OR 1.14 [95% confidence interval (CI) 1.08 to 1.21]), female sex (1.58 [1.38 to 1.82]), low educational level (primary education versus higher vocational/university 1.21 [1.01 to 1.46), poor self-appreciated health (per level decrease 2.00 [1.80 to 2.22]), unemployment (versus employed 2.29 [1.54 to 3.39]), smoking (1.34 [1.08 to 1.65]), concern about contracting COVID-19 (per level increase 1.28 [1.19 to 1.38]) and symptoms of depression (per point increase 1.13 [1.11 to 1.14]) and anxiety (per point increase 1.16 [1.14 to 1.18]). Study limitations included uncertainty about (perceived) severity of the reported symptoms and potentially limited generalisability given the ethnically homogeneous study population.<h4>Conclusions</h4>In this population-based cross-sectional study, 1 in 5 individuals avoided healthcare during lockdown in the COVID-19 pandemic, often for potentially urgent symptoms. Healthcare avoidance was strongly associated with female sex, fragile self-appreciated health, and high levels of depression and anxiety. These results emphasise the need for targeted public education urging these vulnerable patients to timely seek medical care for their symptoms to mitigate major health consequences.Marije J SplinterPremysl VelekM Kamran IkramBrenda C T KieboomRobin P PeetersPatrick J E BindelsM Arfan IkramFrank J WoltersMaarten J G LeeningEvelien I T de SchepperSilvan LicherPublic Library of Science (PLoS)articleMedicineRENPLoS Medicine, Vol 18, Iss 11, p e1003854 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R
spellingShingle	Medicine R Marije J Splinter Premysl Velek M Kamran Ikram Brenda C T Kieboom Robin P Peeters Patrick J E Bindels M Arfan Ikram Frank J Wolters Maarten J G Leening Evelien I T de Schepper Silvan Licher Prevalence and determinants of healthcare avoidance during the COVID-19 pandemic: A population-based cross-sectional study.
description	<h4>Background</h4>During the Coronavirus Disease 2019 (COVID-19) pandemic, the number of consultations and diagnoses in primary care and referrals to specialist care declined substantially compared to prepandemic levels. Beyond deferral of elective non-COVID-19 care by healthcare providers, it is unclear to what extent healthcare avoidance by community-dwelling individuals contributed to this decline in routine healthcare utilisation. Moreover, it is uncertain which specific symptoms were left unheeded by patients and which determinants predispose to healthcare avoidance in the general population. In this cross-sectional study, we assessed prevalence of healthcare avoidance during the pandemic from a patient perspective, including symptoms that were left unheeded, as well as determinants of healthcare avoidance.<h4>Methods and findings</h4>On April 20, 2020, a paper COVID-19 survey addressing healthcare utilisation, socioeconomic factors, mental and physical health, medication use, and COVID-19-specific symptoms was sent out to 8,732 participants from the population-based Rotterdam Study (response rate 73%). All questionnaires were returned before July 10, 2020. By hand, prevalence of healthcare avoidance was subsequently verified through free text analysis of medical records of general practitioners. Odds ratios (ORs) for avoidance were determined using logistic regression models, adjusted for age, sex, and history of chronic diseases. We found that 1,142 of 5,656 included participants (20.2%) reported having avoided healthcare. Of those, 414 participants (36.3%) reported symptoms that potentially warranted urgent evaluation, including limb weakness (13.6%), palpitations (10.8%), and chest pain (10.2%). Determinants related to avoidance were older age (adjusted OR 1.14 [95% confidence interval (CI) 1.08 to 1.21]), female sex (1.58 [1.38 to 1.82]), low educational level (primary education versus higher vocational/university 1.21 [1.01 to 1.46), poor self-appreciated health (per level decrease 2.00 [1.80 to 2.22]), unemployment (versus employed 2.29 [1.54 to 3.39]), smoking (1.34 [1.08 to 1.65]), concern about contracting COVID-19 (per level increase 1.28 [1.19 to 1.38]) and symptoms of depression (per point increase 1.13 [1.11 to 1.14]) and anxiety (per point increase 1.16 [1.14 to 1.18]). Study limitations included uncertainty about (perceived) severity of the reported symptoms and potentially limited generalisability given the ethnically homogeneous study population.<h4>Conclusions</h4>In this population-based cross-sectional study, 1 in 5 individuals avoided healthcare during lockdown in the COVID-19 pandemic, often for potentially urgent symptoms. Healthcare avoidance was strongly associated with female sex, fragile self-appreciated health, and high levels of depression and anxiety. These results emphasise the need for targeted public education urging these vulnerable patients to timely seek medical care for their symptoms to mitigate major health consequences.
format	article
author	Marije J Splinter Premysl Velek M Kamran Ikram Brenda C T Kieboom Robin P Peeters Patrick J E Bindels M Arfan Ikram Frank J Wolters Maarten J G Leening Evelien I T de Schepper Silvan Licher
author_facet	Marije J Splinter Premysl Velek M Kamran Ikram Brenda C T Kieboom Robin P Peeters Patrick J E Bindels M Arfan Ikram Frank J Wolters Maarten J G Leening Evelien I T de Schepper Silvan Licher
author_sort	Marije J Splinter
title	Prevalence and determinants of healthcare avoidance during the COVID-19 pandemic: A population-based cross-sectional study.
title_short	Prevalence and determinants of healthcare avoidance during the COVID-19 pandemic: A population-based cross-sectional study.
title_full	Prevalence and determinants of healthcare avoidance during the COVID-19 pandemic: A population-based cross-sectional study.
title_fullStr	Prevalence and determinants of healthcare avoidance during the COVID-19 pandemic: A population-based cross-sectional study.
title_full_unstemmed	Prevalence and determinants of healthcare avoidance during the COVID-19 pandemic: A population-based cross-sectional study.
title_sort	prevalence and determinants of healthcare avoidance during the covid-19 pandemic: a population-based cross-sectional study.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/6e49e3b151544a469d4f21b9cf20bb5a
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Prevalence and determinants of healthcare avoidance during the COVID-19 pandemic: A population-based cross-sectional study.

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