Barriers to Healthcare Access during COVID-19 Lockdown: A Surgical Point Prevalence Study

Abstract

Abstract

Access to healthcare services and the quality of care received are affected by various factors such as gender, ethnicity, socioeconomic status (SES), and the presence of chronic illnesses. This study aimed to investigate whether the COVID-19 pandemic exacerbated existing disparities in healthcare access. A cross-sectional design was employed, utilizing data from five age-homogenous Indian cohorts born between 1946 and 2002. A web survey was administered to these cohorts, with 14,891 respondents considered eligible for analysis. Main outcomes: The survey assessed the frequency of cancelled surgical or medical appointments and the amount of care received per week during the COVID-19 lockdown. Binary or ordered logistic regression models were used to examine differences in outcomes based on gender, ethnicity, SES, and chronic illness status. Adjustment was made for study design, non-response weights, psychological distress, household composition, COVID-19 infection, employment status, and receipt of a shielding letter. Meta-analyses were conducted across cohorts, with meta-regression assessing the moderating effect of age. Women (OR 1.40, 95% CI 1.27 to 1.55) and individuals with chronic illnesses (OR 1.84, 95% CI 1.65 to 2.05) experienced significantly more appointment cancellations during the lockdown (all p<0.0001). Ethnic minorities and those with chronic illnesses required a higher number of care hours during the lockdown (both OR≈2.00, all p<0.002). SES did not show a significant association with appointment cancellations or care hours. Age was not independently associated with either outcome in the meta-regression analysis.