Prevalence and determinants of healthcare avoidance during the COVID-19 pandemic: A population-based cross-sectional study
During the Coronavirus Disease 2019 (COVID-19) pandemic, the number of consultations and diagnoses in primary care and referrals to specialist care declined substantially compared to prepandemic levels. Beyond deferral of elective non-COVID-19 care by healthcare providers, it is unclear to what exte...
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| Veröffentlicht in: | PLoS medicine 2021-11, Vol.18 (11), p.e1003854-e1003854 |
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| creator | Splinter, Marije J Velek, Premysl Ikram, M Kamran Kieboom, Brenda C T Peeters, Robin P Bindels, Patrick J E Ikram, M Arfan Wolters, Frank J Leening, Maarten J G de Schepper, Evelien I T Licher, Silvan |
| description | During the Coronavirus Disease 2019 (COVID-19) pandemic, the number of consultations and diagnoses in primary care and referrals to specialist care declined substantially compared to prepandemic levels. Beyond deferral of elective non-COVID-19 care by healthcare providers, it is unclear to what extent healthcare avoidance by community-dwelling individuals contributed to this decline in routine healthcare utilisation. Moreover, it is uncertain which specific symptoms were left unheeded by patients and which determinants predispose to healthcare avoidance in the general population. In this cross-sectional study, we assessed prevalence of healthcare avoidance during the pandemic from a patient perspective, including symptoms that were left unheeded, as well as determinants of healthcare avoidance.
On April 20, 2020, a paper COVID-19 survey addressing healthcare utilisation, socioeconomic factors, mental and physical health, medication use, and COVID-19-specific symptoms was sent out to 8,732 participants from the population-based Rotterdam Study (response rate 73%). All questionnaires were returned before July 10, 2020. By hand, prevalence of healthcare avoidance was subsequently verified through free text analysis of medical records of general practitioners. Odds ratios (ORs) for avoidance were determined using logistic regression models, adjusted for age, sex, and history of chronic diseases. We found that 1,142 of 5,656 included participants (20.2%) reported having avoided healthcare. Of those, 414 participants (36.3%) reported symptoms that potentially warranted urgent evaluation, including limb weakness (13.6%), palpitations (10.8%), and chest pain (10.2%). Determinants related to avoidance were older age (adjusted OR 1.14 [95% confidence interval (CI) 1.08 to 1.21]), female sex (1.58 [1.38 to 1.82]), low educational level (primary education versus higher vocational/university 1.21 [1.01 to 1.46), poor self-appreciated health (per level decrease 2.00 [1.80 to 2.22]), unemployment (versus employed 2.29 [1.54 to 3.39]), smoking (1.34 [1.08 to 1.65]), concern about contracting COVID-19 (per level increase 1.28 [1.19 to 1.38]) and symptoms of depression (per point increase 1.13 [1.11 to 1.14]) and anxiety (per point increase 1.16 [1.14 to 1.18]). Study limitations included uncertainty about (perceived) severity of the reported symptoms and potentially limited generalisability given the ethnically homogeneous study population.
In this population-based cross-s |
| doi_str_mv | 10.1371/journal.pmed.1003854 |
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On April 20, 2020, a paper COVID-19 survey addressing healthcare utilisation, socioeconomic factors, mental and physical health, medication use, and COVID-19-specific symptoms was sent out to 8,732 participants from the population-based Rotterdam Study (response rate 73%). All questionnaires were returned before July 10, 2020. By hand, prevalence of healthcare avoidance was subsequently verified through free text analysis of medical records of general practitioners. Odds ratios (ORs) for avoidance were determined using logistic regression models, adjusted for age, sex, and history of chronic diseases. We found that 1,142 of 5,656 included participants (20.2%) reported having avoided healthcare. Of those, 414 participants (36.3%) reported symptoms that potentially warranted urgent evaluation, including limb weakness (13.6%), palpitations (10.8%), and chest pain (10.2%). Determinants related to avoidance were older age (adjusted OR 1.14 [95% confidence interval (CI) 1.08 to 1.21]), female sex (1.58 [1.38 to 1.82]), low educational level (primary education versus higher vocational/university 1.21 [1.01 to 1.46), poor self-appreciated health (per level decrease 2.00 [1.80 to 2.22]), unemployment (versus employed 2.29 [1.54 to 3.39]), smoking (1.34 [1.08 to 1.65]), concern about contracting COVID-19 (per level increase 1.28 [1.19 to 1.38]) and symptoms of depression (per point increase 1.13 [1.11 to 1.14]) and anxiety (per point increase 1.16 [1.14 to 1.18]). Study limitations included uncertainty about (perceived) severity of the reported symptoms and potentially limited generalisability given the ethnically homogeneous study population.
In this population-based cross-sectional study, 1 in 5 individuals avoided healthcare during lockdown in the COVID-19 pandemic, often for potentially urgent symptoms. Healthcare avoidance was strongly associated with female sex, fragile self-appreciated health, and high levels of depression and anxiety. These results emphasise the need for targeted public education urging these vulnerable patients to timely seek medical care for their symptoms to mitigate major health consequences.</description><identifier>ISSN: 1549-1676</identifier><identifier>ISSN: 1549-1277</identifier><identifier>EISSN: 1549-1676</identifier><identifier>DOI: 10.1371/journal.pmed.1003854</identifier><identifier>PMID: 34813591</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Aged ; Aged, 80 and over ; Anxiety ; Anxiety - epidemiology ; Avoidance (Psychology) ; Back pain ; Chronic illnesses ; Communicable Disease Control ; Control ; Coronaviruses ; COVID-19 ; COVID-19 - psychology ; Cross-Sectional Studies ; Delivery of Health Care - statistics & numerical data ; Delivery of Health Care - trends ; Demographic aspects ; Depression - epidemiology ; Disease ; Epidemics ; Epidemiology ; Family physicians ; Female ; Forecasts and trends ; Health aspects ; Health attitudes ; Health care ; Health Facilities ; Health Personnel ; Health services utilization ; Humans ; Male ; Medical records ; Medicine and Health Sciences ; Mental depression ; Mental disorders ; Mental Health - trends ; Middle Aged ; Netherlands ; Netherlands - epidemiology ; Nursing homes ; Pandemics ; Patient Acceptance of Health Care - psychology ; Patients ; Population ; Population studies ; Population-based studies ; Prevalence ; Primary care ; Primary Health Care - trends ; Questionnaires ; Regression analysis ; Research and Analysis Methods ; SARS-CoV-2 - pathogenicity ; Social aspects ; Social Sciences ; Socioeconomic factors ; Surveys and Questionnaires</subject><ispartof>PLoS medicine, 2021-11, Vol.18 (11), p.e1003854-e1003854</ispartof><rights>COPYRIGHT 2021 Public Library of Science</rights><rights>2021 Splinter et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2021 Splinter et al 2021 Splinter et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c764t-cf93a6263db5046d1b7da09eaaffd4fae536cc358839ad6f224dd469df747d673</citedby><cites>FETCH-LOGICAL-c764t-cf93a6263db5046d1b7da09eaaffd4fae536cc358839ad6f224dd469df747d673</cites><orcidid>0000-0002-4143-4839 ; 0000-0001-9067-7362 ; 0000-0001-9075-222X ; 0000-0001-8548-6211 ; 0000-0003-0173-9571 ; 0000-0003-2226-4050 ; 0000-0002-4586-4035 ; 0000-0003-0372-8585 ; 0000-0001-5941-4820</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8610236/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8610236/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,724,777,781,861,882,2096,2915,23847,27905,27906,53772,53774,79349,79350</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34813591$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Basu, Sanjay</contributor><creatorcontrib>Splinter, Marije J</creatorcontrib><creatorcontrib>Velek, Premysl</creatorcontrib><creatorcontrib>Ikram, M Kamran</creatorcontrib><creatorcontrib>Kieboom, Brenda C T</creatorcontrib><creatorcontrib>Peeters, Robin P</creatorcontrib><creatorcontrib>Bindels, Patrick J E</creatorcontrib><creatorcontrib>Ikram, M Arfan</creatorcontrib><creatorcontrib>Wolters, Frank J</creatorcontrib><creatorcontrib>Leening, Maarten J G</creatorcontrib><creatorcontrib>de Schepper, Evelien I T</creatorcontrib><creatorcontrib>Licher, Silvan</creatorcontrib><title>Prevalence and determinants of healthcare avoidance during the COVID-19 pandemic: A population-based cross-sectional study</title><title>PLoS medicine</title><addtitle>PLoS Med</addtitle><description>During the Coronavirus Disease 2019 (COVID-19) pandemic, the number of consultations and diagnoses in primary care and referrals to specialist care declined substantially compared to prepandemic levels. Beyond deferral of elective non-COVID-19 care by healthcare providers, it is unclear to what extent healthcare avoidance by community-dwelling individuals contributed to this decline in routine healthcare utilisation. Moreover, it is uncertain which specific symptoms were left unheeded by patients and which determinants predispose to healthcare avoidance in the general population. In this cross-sectional study, we assessed prevalence of healthcare avoidance during the pandemic from a patient perspective, including symptoms that were left unheeded, as well as determinants of healthcare avoidance.
On April 20, 2020, a paper COVID-19 survey addressing healthcare utilisation, socioeconomic factors, mental and physical health, medication use, and COVID-19-specific symptoms was sent out to 8,732 participants from the population-based Rotterdam Study (response rate 73%). All questionnaires were returned before July 10, 2020. By hand, prevalence of healthcare avoidance was subsequently verified through free text analysis of medical records of general practitioners. Odds ratios (ORs) for avoidance were determined using logistic regression models, adjusted for age, sex, and history of chronic diseases. We found that 1,142 of 5,656 included participants (20.2%) reported having avoided healthcare. Of those, 414 participants (36.3%) reported symptoms that potentially warranted urgent evaluation, including limb weakness (13.6%), palpitations (10.8%), and chest pain (10.2%). Determinants related to avoidance were older age (adjusted OR 1.14 [95% confidence interval (CI) 1.08 to 1.21]), female sex (1.58 [1.38 to 1.82]), low educational level (primary education versus higher vocational/university 1.21 [1.01 to 1.46), poor self-appreciated health (per level decrease 2.00 [1.80 to 2.22]), unemployment (versus employed 2.29 [1.54 to 3.39]), smoking (1.34 [1.08 to 1.65]), concern about contracting COVID-19 (per level increase 1.28 [1.19 to 1.38]) and symptoms of depression (per point increase 1.13 [1.11 to 1.14]) and anxiety (per point increase 1.16 [1.14 to 1.18]). Study limitations included uncertainty about (perceived) severity of the reported symptoms and potentially limited generalisability given the ethnically homogeneous study population.
In this population-based cross-sectional study, 1 in 5 individuals avoided healthcare during lockdown in the COVID-19 pandemic, often for potentially urgent symptoms. Healthcare avoidance was strongly associated with female sex, fragile self-appreciated health, and high levels of depression and anxiety. These results emphasise the need for targeted public education urging these vulnerable patients to timely seek medical care for their symptoms to mitigate major health consequences.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anxiety</subject><subject>Anxiety - epidemiology</subject><subject>Avoidance (Psychology)</subject><subject>Back pain</subject><subject>Chronic illnesses</subject><subject>Communicable Disease Control</subject><subject>Control</subject><subject>Coronaviruses</subject><subject>COVID-19</subject><subject>COVID-19 - psychology</subject><subject>Cross-Sectional Studies</subject><subject>Delivery of Health Care - statistics & numerical data</subject><subject>Delivery of Health Care - trends</subject><subject>Demographic aspects</subject><subject>Depression - epidemiology</subject><subject>Disease</subject><subject>Epidemics</subject><subject>Epidemiology</subject><subject>Family physicians</subject><subject>Female</subject><subject>Forecasts and trends</subject><subject>Health aspects</subject><subject>Health attitudes</subject><subject>Health care</subject><subject>Health Facilities</subject><subject>Health Personnel</subject><subject>Health services utilization</subject><subject>Humans</subject><subject>Male</subject><subject>Medical records</subject><subject>Medicine and Health Sciences</subject><subject>Mental depression</subject><subject>Mental disorders</subject><subject>Mental Health - trends</subject><subject>Middle Aged</subject><subject>Netherlands</subject><subject>Netherlands - epidemiology</subject><subject>Nursing homes</subject><subject>Pandemics</subject><subject>Patient Acceptance of Health Care - psychology</subject><subject>Patients</subject><subject>Population</subject><subject>Population studies</subject><subject>Population-based studies</subject><subject>Prevalence</subject><subject>Primary care</subject><subject>Primary Health Care - trends</subject><subject>Questionnaires</subject><subject>Regression analysis</subject><subject>Research and Analysis Methods</subject><subject>SARS-CoV-2 - pathogenicity</subject><subject>Social aspects</subject><subject>Social Sciences</subject><subject>Socioeconomic factors</subject><subject>Surveys and Questionnaires</subject><issn>1549-1676</issn><issn>1549-1277</issn><issn>1549-1676</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>DOA</sourceid><recordid>eNqVk0tv1DAQxyMEolD4BggiISE4ZLFjx4k5IFXltVJFEY9erYk93k2VtRc7qSifHqe7rbpoDyAfYo1_85_JPLLsCSUzymr6-tyPwUE_W6_QzCghrKn4newBrbgsqKjF3Vv3g-xhjOeElJJIcj87YLyhrJL0Qfb7S8AL6NFpzMGZ3OCAYdU5cEPMvc2XCP2w1BDS84XvDEygGUPnFvmwxPz49Gz-rqAyXydvXHX6TX6Ur_167GHovCtaiGhyHXyMRUQ92aDP4zCay0fZPQt9xMfb72H248P778efipPTj_Pjo5NC14IPhbaSgSgFM21FuDC0rQ0QiQDWGm4BKya0ZlXTMAlG2LLkxnAhja15bUTNDrNnG91176Pali2qUlAieVkJkYj5hjAeztU6dCsIl8pDp64MPiwUhKHTPSqBXCJraZVqy2EKw21JW6ltSdq2gqT1dhttbFNnNLohQL8juvviuqVa-AvVpHxKNiXzcisQ_M8R46BWXdTY9-DQj1PehMqmqghL6PO_0P1_t6UWqc-qc9anuHoSVUei4ZXgZVMlqthDLdBhStI7tF0y7_CzPXw6V1Ow1-HVjkNiBvw1LGCMUc2_ff0P9vO_s6dnu-yLW-xmtqPvx2ks4y7IN-DV5Aa0Nw2kRE3rd11pNa2f2q5fcnt6u_k3Ttf7xv4Ad68qKg</recordid><startdate>20211123</startdate><enddate>20211123</enddate><creator>Splinter, Marije J</creator><creator>Velek, Premysl</creator><creator>Ikram, M Kamran</creator><creator>Kieboom, Brenda C T</creator><creator>Peeters, Robin P</creator><creator>Bindels, Patrick J E</creator><creator>Ikram, M Arfan</creator><creator>Wolters, Frank J</creator><creator>Leening, Maarten J G</creator><creator>de Schepper, Evelien I T</creator><creator>Licher, Silvan</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISN</scope><scope>ISR</scope><scope>3V.</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>COVID</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><scope>CZK</scope><orcidid>https://orcid.org/0000-0002-4143-4839</orcidid><orcidid>https://orcid.org/0000-0001-9067-7362</orcidid><orcidid>https://orcid.org/0000-0001-9075-222X</orcidid><orcidid>https://orcid.org/0000-0001-8548-6211</orcidid><orcidid>https://orcid.org/0000-0003-0173-9571</orcidid><orcidid>https://orcid.org/0000-0003-2226-4050</orcidid><orcidid>https://orcid.org/0000-0002-4586-4035</orcidid><orcidid>https://orcid.org/0000-0003-0372-8585</orcidid><orcidid>https://orcid.org/0000-0001-5941-4820</orcidid></search><sort><creationdate>20211123</creationdate><title>Prevalence and determinants of healthcare avoidance during the COVID-19 pandemic: A population-based cross-sectional study</title><author>Splinter, Marije J ; Velek, Premysl ; Ikram, M Kamran ; Kieboom, Brenda C T ; Peeters, Robin P ; Bindels, Patrick J E ; Ikram, M Arfan ; Wolters, Frank J ; Leening, Maarten J G ; de Schepper, Evelien I T ; Licher, Silvan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c764t-cf93a6263db5046d1b7da09eaaffd4fae536cc358839ad6f224dd469df747d673</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anxiety</topic><topic>Anxiety - 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trends</topic><topic>Middle Aged</topic><topic>Netherlands</topic><topic>Netherlands - epidemiology</topic><topic>Nursing homes</topic><topic>Pandemics</topic><topic>Patient Acceptance of Health Care - psychology</topic><topic>Patients</topic><topic>Population</topic><topic>Population studies</topic><topic>Population-based studies</topic><topic>Prevalence</topic><topic>Primary care</topic><topic>Primary Health Care - trends</topic><topic>Questionnaires</topic><topic>Regression analysis</topic><topic>Research and Analysis Methods</topic><topic>SARS-CoV-2 - pathogenicity</topic><topic>Social aspects</topic><topic>Social Sciences</topic><topic>Socioeconomic factors</topic><topic>Surveys and Questionnaires</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Splinter, Marije J</creatorcontrib><creatorcontrib>Velek, Premysl</creatorcontrib><creatorcontrib>Ikram, M Kamran</creatorcontrib><creatorcontrib>Kieboom, Brenda C T</creatorcontrib><creatorcontrib>Peeters, Robin P</creatorcontrib><creatorcontrib>Bindels, Patrick J E</creatorcontrib><creatorcontrib>Ikram, M Arfan</creatorcontrib><creatorcontrib>Wolters, Frank J</creatorcontrib><creatorcontrib>Leening, Maarten J G</creatorcontrib><creatorcontrib>de Schepper, Evelien I T</creatorcontrib><creatorcontrib>Licher, Silvan</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: Opposing Viewpoints</collection><collection>Gale In Context: Canada</collection><collection>Gale In Context: Science</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Coronavirus Research Database</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><collection>PLoS Medicine</collection><jtitle>PLoS medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Splinter, Marije J</au><au>Velek, Premysl</au><au>Ikram, M Kamran</au><au>Kieboom, Brenda C T</au><au>Peeters, Robin P</au><au>Bindels, Patrick J E</au><au>Ikram, M Arfan</au><au>Wolters, Frank J</au><au>Leening, Maarten J G</au><au>de Schepper, Evelien I T</au><au>Licher, Silvan</au><au>Basu, Sanjay</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prevalence and determinants of healthcare avoidance during the COVID-19 pandemic: A population-based cross-sectional study</atitle><jtitle>PLoS medicine</jtitle><addtitle>PLoS Med</addtitle><date>2021-11-23</date><risdate>2021</risdate><volume>18</volume><issue>11</issue><spage>e1003854</spage><epage>e1003854</epage><pages>e1003854-e1003854</pages><issn>1549-1676</issn><issn>1549-1277</issn><eissn>1549-1676</eissn><abstract>During the Coronavirus Disease 2019 (COVID-19) pandemic, the number of consultations and diagnoses in primary care and referrals to specialist care declined substantially compared to prepandemic levels. Beyond deferral of elective non-COVID-19 care by healthcare providers, it is unclear to what extent healthcare avoidance by community-dwelling individuals contributed to this decline in routine healthcare utilisation. Moreover, it is uncertain which specific symptoms were left unheeded by patients and which determinants predispose to healthcare avoidance in the general population. In this cross-sectional study, we assessed prevalence of healthcare avoidance during the pandemic from a patient perspective, including symptoms that were left unheeded, as well as determinants of healthcare avoidance.
On April 20, 2020, a paper COVID-19 survey addressing healthcare utilisation, socioeconomic factors, mental and physical health, medication use, and COVID-19-specific symptoms was sent out to 8,732 participants from the population-based Rotterdam Study (response rate 73%). All questionnaires were returned before July 10, 2020. By hand, prevalence of healthcare avoidance was subsequently verified through free text analysis of medical records of general practitioners. Odds ratios (ORs) for avoidance were determined using logistic regression models, adjusted for age, sex, and history of chronic diseases. We found that 1,142 of 5,656 included participants (20.2%) reported having avoided healthcare. Of those, 414 participants (36.3%) reported symptoms that potentially warranted urgent evaluation, including limb weakness (13.6%), palpitations (10.8%), and chest pain (10.2%). Determinants related to avoidance were older age (adjusted OR 1.14 [95% confidence interval (CI) 1.08 to 1.21]), female sex (1.58 [1.38 to 1.82]), low educational level (primary education versus higher vocational/university 1.21 [1.01 to 1.46), poor self-appreciated health (per level decrease 2.00 [1.80 to 2.22]), unemployment (versus employed 2.29 [1.54 to 3.39]), smoking (1.34 [1.08 to 1.65]), concern about contracting COVID-19 (per level increase 1.28 [1.19 to 1.38]) and symptoms of depression (per point increase 1.13 [1.11 to 1.14]) and anxiety (per point increase 1.16 [1.14 to 1.18]). Study limitations included uncertainty about (perceived) severity of the reported symptoms and potentially limited generalisability given the ethnically homogeneous study population.
In this population-based cross-sectional study, 1 in 5 individuals avoided healthcare during lockdown in the COVID-19 pandemic, often for potentially urgent symptoms. Healthcare avoidance was strongly associated with female sex, fragile self-appreciated health, and high levels of depression and anxiety. These results emphasise the need for targeted public education urging these vulnerable patients to timely seek medical care for their symptoms to mitigate major health consequences.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>34813591</pmid><doi>10.1371/journal.pmed.1003854</doi><orcidid>https://orcid.org/0000-0002-4143-4839</orcidid><orcidid>https://orcid.org/0000-0001-9067-7362</orcidid><orcidid>https://orcid.org/0000-0001-9075-222X</orcidid><orcidid>https://orcid.org/0000-0001-8548-6211</orcidid><orcidid>https://orcid.org/0000-0003-0173-9571</orcidid><orcidid>https://orcid.org/0000-0003-2226-4050</orcidid><orcidid>https://orcid.org/0000-0002-4586-4035</orcidid><orcidid>https://orcid.org/0000-0003-0372-8585</orcidid><orcidid>https://orcid.org/0000-0001-5941-4820</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1549-1676 |
| ispartof | PLoS medicine, 2021-11, Vol.18 (11), p.e1003854-e1003854 |
| issn | 1549-1676 1549-1277 1549-1676 |
| language | eng |
| recordid | cdi_plos_journals_2610942566 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Public Library of Science (PLoS); PubMed Central |
| subjects | Aged Aged, 80 and over Anxiety Anxiety - epidemiology Avoidance (Psychology) Back pain Chronic illnesses Communicable Disease Control Control Coronaviruses COVID-19 COVID-19 - psychology Cross-Sectional Studies Delivery of Health Care - statistics & numerical data Delivery of Health Care - trends Demographic aspects Depression - epidemiology Disease Epidemics Epidemiology Family physicians Female Forecasts and trends Health aspects Health attitudes Health care Health Facilities Health Personnel Health services utilization Humans Male Medical records Medicine and Health Sciences Mental depression Mental disorders Mental Health - trends Middle Aged Netherlands Netherlands - epidemiology Nursing homes Pandemics Patient Acceptance of Health Care - psychology Patients Population Population studies Population-based studies Prevalence Primary care Primary Health Care - trends Questionnaires Regression analysis Research and Analysis Methods SARS-CoV-2 - pathogenicity Social aspects Social Sciences Socioeconomic factors Surveys and Questionnaires |
| title | Prevalence and determinants of healthcare avoidance during the COVID-19 pandemic: A population-based cross-sectional study |
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