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193. Foregone Health Care Among U.S. Adolescents and Children During the COVID-19 Pandemic— COVID Experiences Surveys, Wave 2, March–May, 2021

      Purpose

      The COVID-19 pandemic resulted in disruptions to the U.S. health care system, which may contribute to foregoing health care (i.e., needed care that was not sought after or received). We describe the impact of the pandemic on adolescent and pediatric foregone health care by sociodemographic characteristics and experiences of racism.

      Methods

      Data were from the second wave (March-May 2021) of the COVID Experiences Surveys (CovEx) and captured experiences of adolescents ages 13-19 directly (n = 569) and children ages 5-12 via parent report (n = 1287) using a probability-based sample representative of the U.S. household population. An item assessing health care that was foregone for any reason was included in the adolescent (i.e., thinking you should have sought health care but did not) and parent surveys (i.e., having any health care visits delayed, missed, or not scheduled for the child) since the first wave of CovEx (i.e., approximately a 6-month recall period). Participants who reported this experience were asked to categorize the type of health care foregone (e.g., well-child visit, STD testing or treatment). We report the prevalence of foregone health care and test for differences by age, sex, race/ethnicity, insurance status, and experiences of racism for both adolescents and children and differences by sexual identity among adolescents only, reporting prevalence by subgroup when p<0.05.

      Results

      The prevalence of foregone health care among adolescents ages 13-19 years was 20.4% (95% CI: 16.4%, 25.2%). Female, 16- to 19-year-old, and lesbian, gay, or bisexual adolescents were more likely to report foregone health care compared to male (26.8% vs. 14.1%), 13- to 15-year-old (26.3% vs. 12.9%), and heterosexual adolescents (48.2% vs. 15.1%), respectively. Among adolescents experiencing foregone care, the three most prevalent types of care were mental health services (37.9%), sickness (26.9%), and a check-up or sports physical (22.1%). Based on parent report, the prevalence of foregone health care among children ages 5-12 was 16.3% (95% CI: 14.2%, 18.7%). Parent report of their child foregoing health care differed by child’s race/ethnicity at 21.6% among non-Hispanic other/multiracial, 21.0% among Hispanic, 14.8% among non-Hispanic Black, and 13.2% among non-Hispanic White children. Parents who reported their child had experienced racism were more likely to report foregone health care for their child than parents who did not (43.3% vs. 14.5%). Among children experiencing foregone care, the three most prevalent types of care were well-child check-up or sports physical (64.0%), immunizations (19.8%), and sick child visits (14.3%).

      Conclusions

      Approximately a fifth of adolescents and children had foregone needed health care over an approximate 6-month recall period in 2021, with disparities by age, sex, race, sexual identity, and experiences of racism. Although foregone health care may have been attributable to closures in medical offices early in the pandemic, the current data were collected after most stay-at-home orders were lifted and public health recommendations stressed seeking routine health care. Increasing availability and accessibility of health care to U.S. youth, particularly populations disproportionately more likely to forego health care is needed to eliminate documented disparities in unmet health care needs.

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