Two out of five individuals delayed or missed medical care in the early phase of the pandemic—from March through mid-July 2020—according to a new survey from researchers at the Johns Hopkins Bloomberg School of Public Health.

The survey of 1,337 U.S. adults found that 544, or 41 percent, delayed or missed medical care during the survey period. Among the 1,055 individuals who reported needing medical care, 29 percent (307 respondents), indicated fear of transmission of COVID-19 as the main reason. Seven percent (75 respondents) reported financial concerns as the main reason for delaying or missing care.

The findings were published online in JAMA Network Open on January 21.

“Understanding the reasons individuals forgo care is important in order to design policy and clinical interventions to limit the extent of forgone care,” says lead author Kelly Anderson, a doctoral student in the Department of Health Policy and Management at the Bloomberg School. “This is particularly relevant as COVID-19 cases are surging again.”

During the initial phase of the COVID-19 pandemic, the U.S. health care system experienced major disruptions including the closures of medical practices, cancelation of elective procedures, and the shift of many health services to telehealth. As a result of the disruptions, many individuals missed or postponed medical care which can lead to increased health complications, cost, and delayed diagnosis.

The survey, part of Johns Hopkins COVID-19 Civic Life and Public Health Survey, was fielded from July 7 to July 22, 2020. The sample was drawn from NORC’s Amerispeak Panel, a nationally representative online sample of U.S. households. Respondents were asked whether they missed several types of care, including doses of prescription medications, scheduled preventive care visits, scheduled outpatient medical or mental health visits, elective surgical procedures, or care for new severe physical or mental health issues.

Among the 1,337 survey respondents, 29 percent (387 respondents) reported missing a preventive care visit, 26 percent (343 respondents) reported missing an outpatient general medical appointment, 8 percent (108 respondents) reported missing one or more doses of a prescription medication, 8 percent (105 respondents) reported missing an outpatient mental health appointment, 6 percent (77 respondents) reported missing an elective surgery, and 3 percent (38 respondents) reported not receiving health care for a new severe mental or physical health issue.

Among the 1,055 individuals who reported needing medical care from March to mid-July 2020, more than half, 52 percent (554 respondents) reported missing care. Among those, 58 percent who had a scheduled preventive care appointment missed the appointment and 60 percent (77 respondents) with a scheduled elective surgical procedure forwent the procedure. Approximately half, 51 percent (38 respondents), of respondents with a new severe mental health or physical health issue that started after the start of the pandemic, reported not seeking care for a new health issue.

The survey also found disruptions to prescription medication. Among 725 respondents who reported taking a prescription medication, three times as many Hispanic respondents reported missing prescription medications compared to non-Hispanic, white respondents—30 percent (33 of 109 respondents) compared to 10 percent (50 of 482 respondents). Twenty-two percent of respondents from 18 to 34 reported missing prescription medication (45 of 204 respondents) compared to 6 percent of adults over 65 (10 of 160 respondents) and 16 percent of aged 35-49 (29 of 182 respondents). Twenty-seven percent of respondents in households with incomes less than $35,000 dollars a year reported missing prescription medications compared to 6 percent of respondents in households with higher incomes of at least $75,000 (66 of 244 respondents and 16 of 255 respondents). Thirty-six percent of individuals insured through Medicaid reported a higher frequency of missed prescription medications (41 of 114 respondents), as compared to 10 percent of individuals with commercial insurance (52 of 517 respondents).

Finally, among those who reported needing medical care, respondents who were unemployed reported higher frequencies of any forgone medical care (65 percent versus 50 percent, 121 of 186 respondents and 251 of 503 respondents, respectively), missed doses of medications (39 percent versus 13 percent, 46 of 117 respondents and 46 of 367 respondents, respectively), and missed scheduled appointments (70 percent versus 56 percent, 111 of 159 respondents and 225 of 405 respondents, respectively) as compared to individuals who were employed.

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