COVID-19 大流行期间成年人未满足的医疗保健需求：加拿大老龄化纵向研究中的一项前瞻性队列研究。
Unmet health care needs during the COVID-19 pandemic among adults: a prospective cohort study in the Canadian Longitudinal Study on Aging.
机构信息
Department of Health Research Methods, Evidence, and Impact (Khattar, Anderson, De Rubeis, Jones, Griffith, Raina), McMaster University, Hamilton, Ont.; Applied Research Division (de Groh, Jiang), Center for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Department of Epidemiology, Biostatistics and Occupational Health (Basta, Wolfson), School of Population and Global Health, McGill University, Montréal, Que.; Department of Community Health and Epidemiology and Division of Geriatric Medicine (Kirkland), Dalhousie University, Halifax, NS.
Department of Health Research Methods, Evidence, and Impact (Khattar, Anderson, De Rubeis, Jones, Griffith, Raina), McMaster University, Hamilton, Ont.; Applied Research Division (de Groh, Jiang), Center for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Department of Epidemiology, Biostatistics and Occupational Health (Basta, Wolfson), School of Population and Global Health, McGill University, Montréal, Que.; Department of Community Health and Epidemiology and Division of Geriatric Medicine (Kirkland), Dalhousie University, Halifax, NS
出版信息
CMAJ Open. 2023 Feb 14;11(1):E140-E151. doi: 10.9778/cmajo.20210320. Print 2023 Jan-Feb.
BACKGROUND
The COVID-19 pandemic affected access to health care services in Canada; however, limited research examines the influence of the social determinants of health on unmet health care needs during the first year of the pandemic. The objectives of this study were to describe unmet health care needs during the first year of the pandemic and to investigate the association of unmet needs with the social determinants of health.
METHODS
We conducted a prospective cohort study of 23 972 adults participating in the Canadian Longitudinal Study on Aging (CLSA) COVID-19 Study (April-December 2020) to identify the social determinants of health associated with unmet health care needs during the pandemic. Using logistic regression, we assessed the association between several social determinants of health on the following 3 outcomes (separately): experiencing any challenges in accessing health care services, not going to a hospital or seeing a doctor when needed, and experiencing barriers to accessing testing for SARS-CoV-2 infection.
RESULTS
From September to December 2020, 25% of participants experienced challenges accessing health care services, 8% did not go to a hospital or see a doctor when needed and 4% faced barriers accessing testing for SARS-CoV-2 infection. The prevalence of all 3 unmet need outcomes was lower among older age groups. Differences were observed by sex, region, education, income and racial background. Immigrants (odds ratio [OR] 1.18, 95% confidence interval [CI] 1.09-1.27) or people with chronic conditions (OR 1.35, 95% CI 1.27-1.43) had higher odds of experiencing challenges accessing health care services and had higher odds of not going to a hospital or seeing a doctor (immigrants OR 1.26, 95% CI 1.11-1.43; chronic conditions OR 1.45, 95% CI 1.31-1.61). Prepandemic unmet health care needs were strongly associated with all 3 outcomes.
INTERPRETATION
Substantial unmet health care needs were reported by Canadian adults during the first year of the pandemic. The results of this study have important implications for health equity.
背景
COVID-19 大流行影响了加拿大的医疗服务获取；然而，有限的研究考察了大流行第一年期间健康的社会决定因素对未满足的医疗需求的影响。本研究的目的是描述大流行第一年期间未满足的医疗需求，并调查未满足的需求与健康的社会决定因素之间的关联。
方法
我们对参加加拿大老龄化纵向研究（CLSA）COVID-19 研究（2020 年 4 月至 12 月）的 23972 名成年人进行了一项前瞻性队列研究，以确定与大流行期间医疗服务未满足需求相关的健康的社会决定因素。使用逻辑回归，我们评估了以下 3 个结果（分别）中几种健康的社会决定因素之间的关联：在医疗服务获取方面遇到挑战，在需要时不去医院或看医生，以及在获得 SARS-CoV-2 感染检测方面遇到障碍。
结果
2020 年 9 月至 12 月期间，25%的参与者在获取医疗服务方面遇到挑战，8%的人在需要时不去医院或看医生，4%的人在获得 SARS-CoV-2 感染检测方面遇到障碍。所有 3 种未满足需求的结果的患病率在年龄较大的年龄组中较低。在性别、地区、教育、收入和种族背景方面存在差异。移民（比值比[OR]1.18，95%置信区间[CI]1.09-1.27）或患有慢性疾病的人（OR1.35，95%CI1.27-1.43）在获取医疗服务方面遇到挑战的可能性更高，并且更有可能不去医院或看医生（移民 OR1.26，95%CI1.11-1.43；慢性疾病 OR1.45，95%CI1.31-1.61）。大流行前未满足的医疗需求与所有 3 个结果密切相关。
解释
加拿大成年人在大流行的第一年报告了大量未满足的医疗需求。本研究的结果对健康公平具有重要意义。
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