Unmet health care needs during the COVID-19 pandemic among adults: a prospective cohort study in the Canadian Longitudinal Study on Aging

Living with osteoarthritis pain during COVID-19: perspectives of Black and White Canadians

OBJECTIVE

This study examines the lived experience and daily impact of hip and knee osteoarthritis pain in Black and White Canadians in the context of the COVID-19 pandemic.

METHODS

An interpretative description approach was used. Recruitment was tailored to engage a diverse sample. During semi-structured, one-on-one interviews, participants reflected on their pain, its impact, and strategies for its management. A constant comparative approach was used. Standardized questionnaires collected gender, race, and OA severity to describe the sample.

RESULTS

Thirty participants (15 Black, 15 White) with moderate knee and hip symptoms participated. OA pain was experienced on two continua. A continuum of control ranged from OA pain versus the participant controlling decisions to participate in daily activities. A continuum of certainty ranged from doubting versus feeling confident in the ability to manage OA pain. These continua intersected, creating quadrants. Pain controlling decisions and uncertainty led to a quadrant of feeling worn out. Pain controlling decisions and certainty resulted in a quadrant of unmet expectations. The participant controlling decisions combined with uncertainty was experienced as coping. The participant controlling decisions combined with certainty in managing OA pain created overcoming. Contextual factors that influenced these continua included COVID-19 restrictions, housing, employment, interactions with healthcare providers, and health literacy.

CONCLUSION

Participants' experiences of OA pain were linked to the sense of control in daily decisions and certainty in managing OA pain, reflecting concepts of locus of control and self-efficacy. Sociocultural factors, life experiences, and issues such as employment, housing, COVID-19 restrictions, and health literacy shaped these experiences.

National Trends in the Prevalence of Unmet Health Care and Dental Care Needs During the COVID-19 Pandemic: Longitudinal Study in South Korea, 2009-2022

BACKGROUND

Although previous studies have investigated trends in unmet health care and dental care needs, most have focused on specific groups, such as patients with chronic conditions and older adults, and have been limited by smaller data sets.

OBJECTIVE

This study aims to investigate the trends and relative risk factors for unmet health care and dental care needs, as well as the impact of the COVID-19 pandemic on these needs.

METHODS

We assessed unmet health care and dental care needs from 2009 to 2022 using data from the Korea Community Health Survey (KCHS). Our analysis included responses from 2,750,212 individuals. Unmet health care or dental care needs were defined as instances of not receiving medical or dental services deemed necessary by experts or desired by patients.

RESULTS

From 2009 to 2022, the study included 2,700,705 individuals (1,229,671 men, 45.53%; 673,780, 24.95%, aged 19-39 years). Unmet health care needs decreased before the COVID-19 pandemic; however, during the pandemic, there was a noticeable increase (βdiff 0.10, 95% CI 0.09-0.11). Unmet dental care needs declined before the pandemic and continued to decrease during the pandemic (βdiff 0.23, 95% CI 0.22-0.24). Overall, the prevalence of unmet dental care needs was significantly higher than that for unmet health care needs. While the prevalence of unmet health care needs generally decreased over time, the β difference during the pandemic increased compared with prepandemic values.

CONCLUSIONS

Our study is the first to analyze national unmet health care and dental care needs in South Korea using nationally representative, long-term, and large-scale data from the KCHS. We found that while unmet health care needs decreased during COVID-19, the decline was slower compared with previous periods. This suggests a need for more targeted interventions to prevent unmet health care and dental care needs.

Delayed Access to Medical Care and Psychological Distress among Chinese Immigrants in Canada during the Pandemic

The psychological impact of medical care accessibility during the pandemic has been widely studied, but little attention has been given to Asian immigrants in Canada. This study aimed to fill this literature gap by using a cross-sectional survey, which aimed to evaluate the impact of the COVID-19 pandemic on Chinese immigrants in North America during the second wave of the pandemic. The study focused on Chinese immigrants aged 16 or older in Canada. Covariates included sociodemographic variables, delayed access to medical care (i.e., treatment or health assessment), and other COVID-19 related variables. We used logistic LASSO regression for model selection and multivariate logistic regression models to evaluate the association between delayed access to treatment/health assessment and psychological distress outcome, as measured by the COVID-19 Peritraumatic Distress Index (CPDI). Missing data were handled using multiple imputation. Our study included 746 respondents, with 47.18% in the normal CPDI group and 36.82% in the mild-to-severe CPDI group. Most respondents were originally from Mainland China and residing in Ontario. Over half have stayed in Canada for at least 15 years. The multivariate logistic regression models identified significant risk predictors of psychological distress status: delayed access to medical care (OR = 1.362, 95% CI: 1.078-1.720, p = 0.0095), fear of COVID-19 (OR = 1.604, 95% CI: 1.293-1.989, p < 0.0001), and social loneliness (OR = 1.408, 95%CI: 1.314-1.508, p < 0.0001). Sociodemographic variables and other COVID-19-related variates did not significantly impact the study's outcome. Our findings shed light on the importance of timely medical care access to psychological well-being among Chinese Canadians. Reliable health information, mental health support, and virtual care tailored to immigrants should be considered to mitigate this impact and promote their overall health and well-being.

The Access Paradox: unmet healthcare needs among young adults in Alberta - an exploratory study of the systemic ironies in healthcare accessibility

There is a pressing need to investigate how young adults' access to healthcare, including how delayed help-seeking behaviours and the complexities inherent in traditional healthcare systems, exacerbate the challenges they face. This study explores the associations among functional impairments, self-perceptions of health, anxiety and mood disorders and their potential relationship to unmet healthcare needs among young adults aged 20-29. This cross-sectional study used data from the 2017-2018 Canadian Community Health Survey to analyse a sample of 1636 young adults from Alberta, Canada. Central to the analysis was the application of conceptual framework of access to health care, as it offers a comprehensive view of healthcare access. Among the sampled young adults, 7.0% reported unmet healthcare needs. Self-perceived unmet healthcare needs were significantly associated with anxiety disorders, functional impairments-specifically cognitive and social skills, and self-perceptions of poor or fair mental health, as opposed to those perceiving their mental health as excellent. Multivariable analyses incorporating extraneous variables were not statistically significant, emphasising the critical role of systemic and structural factors in healthcare access. The study presents preliminary insights into the intricate dynamics shaping unmet healthcare needs. These insights can guide future research and practice advances, particularly in developing targeted interventions that effectively reduce healthcare disparities and enhance access to healthcare services for young adults.

The Association Between Hospital-Based Food Pantry Use and Subsequent Emergency Department Utilization Among Medicaid Patients With Diabetes

We explored the association between the use of a hospital-based food pantry and subsequent emergency department (ED) utilization among Medicaid patients with diabetes in a large safety-net health system. Leveraging 2015-2019 electronic health record data, we used a staggered difference-in-differences approach to measure changes in ED use before vs after food pantry use. Food pantry use was associated with a 7.3 percentage point decrease per patient per quarter (95% confidence interval, -13.8 to -0.8) in the probability of subsequent ED utilization ( P = .03). Addressing food insecurity through hospital-based food pantries may be one mechanism for reducing ED use among low-income patients with diabetes.

A comparison of factors associated with unmet healthcare needs in people with disabilities before and after COVID-19: a nationally representative population-based study

BACKGROUND

People with disabilities, who require numerous healthcare services, are vulnerable to unmet healthcare needs. This study aimed to investigate and identify the factors that influence unmet healthcare needs among people with disabilities and to compare these factors before and after the COVID-19 pandemic in South Korea.

METHODS

A propensity score matching analysis was conducted using two datasets from the National Survey of Disabled Persons collected in 2017 and 2020. The participants were matched based on variables known to influence healthcare utilization. Based on the Andersen model, logistic regression was performed to analyze the key characteristics of the factors associated with unmet healthcare needs, including predisposing, enabling, and need factors.

RESULTS

Propensity score matching resulted in the inclusion of 1,884 participants in each group: an experimental group and control group. Before COVID-19, factors associated with unmet healthcare needs included sex, age, marital status, and education level (predisposing factors), instrumental activities of daily living dependency, satisfaction with medical staff's understanding of disability, satisfaction with medical institutional facilities and equipment (enabling factors), subjective health status, and depressive symptoms (need factors). After COVID-19, factors included physical disability, instrumental activities of daily living dependency, and discrimination (enabling factors), and subjective health status, chronic diseases, depressive symptoms, and regular medical care (need factors). No significant predisposing factors affecting unmet healthcare needs were identified after COVID-19.

CONCLUSIONS

This study compared the factors affecting unmet healthcare needs among people with disabilities before and after COVID-19. Recognizing the different factors associated with unmet healthcare needs before and after COVID-19, (e.g., sex, type of disability, satisfaction with medical staff's understanding of disabilities, medical institutional facilities and equipment considering the disabled, discrimination, chronic diseases, and regular medical care) may help governments and policymakers establish strategies to reduce and prevent unmet healthcare needs during and a future crisis.

How did unmet care needs during the pandemic affect health outcomes of older European individuals?

The first wave of the COVID-19 pandemic left many people with unmet health care needs, which could have detrimental effects on their health. This paper examines the effects of these unmet needs during the first wave of the pandemic on health outcomes one year later. We combine two waves of the SHARE survey collected during the COVID-19 pandemic (in June/July 2020 and 2021), as well as four waves collected before the pandemic. Our health outcomes are four dummy variables: fatigue, falling, fear of falling and dizziness/faints/blackouts issues. Finally, we use OLS regression with individual and time fixed effects for our difference-in-difference analysis, as well as a doubly robust estimator to condition the parallel trend assumption on pre-pandemic covariates. We find substantial effects of having had unmet healthcare needs during 2020 on the probability of having trouble with fatigue and fear of falling one year later. We particularly find strong effects for general practitioner (GP) and specialist care, and in lower extent of physiotherapist, psychotherapist, and rehabilitation care.