An evaluation of the impact of social and structural determinants of health on forgone care during the COVID-19 pandemic in Baltimore, Maryland

Diane Meyer; Kelly Lowensen; Nancy Perrin; Ayana Moore; Shruti H Mehta; Cheryl R Himmelfarb; Thomas V Inglesby; Jacky M Jennings; Alexandra K Mueller; Jessica N LaRicci; Woudase Gallo; Adam P Bocek; Jason E Farley

doi:10.1371/journal.pone.0302064

An evaluation of the impact of social and structural determinants of health on forgone care during the COVID-19 pandemic in Baltimore, Maryland

PLoS One. 2024 May 13;19(5):e0302064. doi: 10.1371/journal.pone.0302064. eCollection 2024.

Authors

Affiliations

¹ Center for Infectious Disease and Nursing Innovation, Johns Hopkins University, School of Nursing, Baltimore, MD, United States of America.
² Center for Health Security, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, United States of America.
³ Johns Hopkins University, School of Nursing, Baltimore, MD, United States of America.
⁴ FHI 360, Durham, NC, United States of America.
⁵ Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, United States of America.
⁶ Department of Pediatrics, Johns Hopkins University, School of Medicine, Baltimore, MD, United States of America.

Abstract

Evidence suggests that reductions in healthcare utilization, including forgone care, during the COVID-19 pandemic may be contributing towards excess morbidity and mortality. The objective of this study was to describe individual and community-level correlates of forgone care during the COVID-19 pandemic. We conducted a cross-sectional, secondary data analysis of participants (n = 2,003) who reported needing healthcare in two population-representative surveys conducted in Baltimore, MD in 2021 and 2021-2022. Abstracted data included the experience of forgone care, socio-demographic data, comorbidities, financial strain, and community of residence. Participant's community of residence were linked with data acquired from the Baltimore Neighborhood Indicators Alliance relevant to healthcare access and utilization, including walkability and internet access, among others. The data were analyzed using weighted random effects logistic regression. Individual-level factors found to be associated with increased odds for forgone care included individuals age 35-49 (compared to 18-34), female sex, experiencing housing insecurity during the pandemic, and the presence of functional limitations and mental illness. Black/African American individuals were found to have reduced odds of forgone care, compared to any other race. No community-level factors were significant in the multilevel analyses. Moving forward, it will be critical that health systems identify ways to address any barriers to care that populations might be experiencing, such as the use of mobile health services or telemedicine platforms. Additionally, public health emergency preparedness planning efforts must account for the unique needs of communities during future crises, to ensure that their health needs can continue to be met. Finally, additional research is needed to better understand how healthcare access and utilization practices have changed during versus before the pandemic.

Copyright: © 2024 Meyer et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Adolescent
Adult
Aged
Baltimore / epidemiology
COVID-19* / epidemiology
Cross-Sectional Studies
Female
Health Services Accessibility
Humans
Male
Middle Aged
Pandemics*
Patient Acceptance of Health Care / statistics & numerical data
SARS-CoV-2
Social Determinants of Health
Young Adult

Grants and funding

Research reported in this publication was supported by the National Institute of Nursing Research (award number 1F31NR080834-01) and the National Institute of Allergy and Infectious Diseases of the National Institutes of Health under award numbers P30AI094189-09S1 and UM1AI068619. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.