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. 2023 Jul-Aug;138(4):633-644.
doi: 10.1177/00333549231163527. Epub 2023 Apr 4.

Persistent Disparities in Pediatric Health Care Engagement During the COVID-19 Pandemic

Thao-Ly T Phan  1   2   3 , Paul T Enlow  1   2   3 , Amanda M Lewis  1   2 , Kamyar Arasteh  1   2 , Aimee K Hildenbrand  1   2   3 , Julia Price  1   2   3 , Corinna L Schultz  1   2   3 , Victoria Reynolds  4 , Anne E Kazak  1   2   3 , Melissa A Alderfer  1   2   3
Affiliations

Persistent Disparities in Pediatric Health Care Engagement During the COVID-19 Pandemic

Thao-Ly T Phan et al. Public Health Rep. 2023 Jul-Aug.

Abstract

Objective: The COVID-19 pandemic has disrupted traditional health care, including pediatric health care. We described the impact of the pandemic on disparities in pediatric health care engagement.

Methods: Using a population-based cross-sectional time-series design, we compared monthly ambulatory care visit volume and completion rates (completed vs no-show and cancelled visits) among pediatric patients aged 0-21 years in 4 states in the mid-Atlantic United States during the first year of the COVID-19 pandemic (March 2020-February 2021) with the same period before the pandemic (March 2019-February 2020). We used unadjusted odds ratios, stratified by visit type (telehealth or in-person) and sociodemographic characteristics (child race and ethnicity, caregiver primary language, geocoded Child Opportunity Index, and rurality).

Results: We examined 1 556 548 scheduled ambulatory care visits for a diverse pediatric patient population. Visit volume and completion rates (mean, 70.1%) decreased during the first months of the pandemic but returned to prepandemic levels by June 2020. Disparities in in-person visit completion rates among non-Hispanic Black versus non-Hispanic White patients (64.9% vs 74.3%), patients from socioeconomically disadvantaged versus advantaged communities as measured by Child Opportunity Index (65.8% vs 76.4%), and patients in rural versus urban neighborhoods (66.0% vs 70.8%) were the same during the remainder of the first year of the pandemic as compared with the previous year. Concurrent with large increases in telehealth (0.5% prepandemic, 19.0% during the pandemic), telehealth completion rates increased.

Conclusions: Disparities in pediatric visit completion rates that existed before the pandemic persisted during the pandemic. These findings underscore the need for culturally tailored practices to reduce disparities in pediatric health care engagement.

Keywords: COVID-19; health care utilization; health disparities; telehealth.

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Conflict of interest statement

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Ambulatory care visit completion rates among non-Hispanic White and non-Hispanic Black pediatric patients (ages 0-21 years) before (March 2019–February 2020) and during (March 2020–February 2021) the COVID-19 pandemic, by race (Black or White), type of visit (A, in-person visits; B, telehealth visits), and month. Visit completion rates are from data on >1.5 million visits. To right, unadjusted odds ratios for visit completion by month (Black vs White [reference]). Error bars indicate 95% CIs.
Figure 2.
Figure 2.
Ambulatory care visit completion rates among pediatric patients (ages 0-21 years) before (March 2019–February 2020) and during (March 2020–February 2021) the COVID-19 pandemic, by primary language of caregiver (non-English or English), type of visit (A, in-person; B, telehealth), and month. Visit completion rates are from data on >1.5 million visits. To right, unadjusted odds ratios for visit completion by month (non-English vs English [reference]). Error bars indicate 95% CIs.
Figure 3.
Figure 3.
Ambulatory care visit completion rates among pediatric patients (ages 0-21 years) before (March 2019–February 2020) and during (March 2020–February 2021) the COVID-19 pandemic, by neighborhood Child Opportunity Index (COI), type of visit (A, in-person visits; B, telehealth visits), and month. Visit completion rates are from data on >1.5 million pediatric (ages 1-21 years) visits. The 2 groups are those with the highest (COI-5) and lowest (COI-1) completion rates. To right, unadjusted odds ratios for visit completion by month (COI-1 vs COI-5 [reference]). Error bars indicate 95% CIs.
Figure 4.
Figure 4.
Ambulatory care visit completion rates among pediatric patients (ages 0-21 years) before (March 2019–February 2020) and during (March 2020–February 2021) the COVID-19 pandemic, by neighborhood rurality (rural or nonrural), type of visit (A, in-person; B, telehealth), and month. Visit completion rates are from data on >1.5 million visits. To right, unadjusted odds ratios for visit completion (families from rural neighborhoods vs nonrural neighborhoods [reference]). Error bars indicate 95% CIs.
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