Delayed Care Among Low-Income Adults during the COVID-19 Pandemic: A US Population-Based Study

OBJECTIVES: To characterize delayed care patterns by income status during the COVID-19 pandemic among US adults.

METHODS: This study analyzed the 2020 Medical Expenditure Panel Survey Full Year Consolidated Data File. The study defined low- or middle-income individuals as those in families with income less than 400 percent of the poverty line and selected covariates using Anderson's Behavioral Model of Health Services Use. The sociodemographic and health-related variables were compared by income status using chi-square tests. The sampling weights were applied to account for complex survey design and generate nationally representative estimates.

RESULTS: A total of 21,234 US adults answered the COVID-19-related questions, about 46.9% including low- or middle-income adults. During the COVID-19 pandemic, compared to high-income adults, a lower proportion of low/middle-income adults reported delaying medical care (15.8% vs. 17.5%; p=0.005) or dental care (21.1% vs. 30.0%; p=<.0001). However, before the pandemic, low/middle-income adults than high-income adults were more likely to defer medical care (9.2% vs. 4.5%; p=<.0001) or dental care (17.3% vs. 7.3%; p=<.0001) to save costs. Prescription drug filling was not affected much by the COVID-19 pandemic for both low/middle- (1.9%) and high-income adults (1.2%). During the pandemic, low-or middle-income adults were more likely to self-rate their physical (16.7% vs. 7.4%; p=<.0001) and mental health (12.7% vs. 6.4%; p=<.0001) as fair or poor. Most high-income adults, as opposed to low/middle-income counterparts, were covered by private insurance (86.3% vs. 52.6%), non-Hispanic white (71.1% vs. 54.4%), and had a usual source of care provider (75.4% vs. 67.9%).

CONCLUSIONS: High-income US adults appeared to experience more COVID-19-related delays in health care compared with low- or middle-income counterparts. Multivariable regression will be conducted to produce the adjusted estimates of delayed care prevalence.