Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
JAMA Netw Open. 2021 Jan 4;4(1):e2034882. doi: 10.1001/jamanetworkopen.2020.34882.
The coronavirus disease 2019 (COVID-19) pandemic has caused major disruptions in the US health care system.
To estimate frequency of and reasons for reported forgone medical care from March to mid-July 2020 and examine characteristics of US adults who reported forgoing care.
DESIGN, SETTING, AND PARTICIPANTS: This survey study used data from the second wave of the Johns Hopkins COVID-19 Civic Life and Public Health Survey, fielded from July 7 to July 22, 2020. Respondents included a national sample of 1337 individuals aged 18 years or older in the US who were part of National Opinion Research Center's AmeriSpeak Panel.
The initial period of the COVID-19 pandemic in the US, defined as from March to mid-July 2020.
The primary outcomes were missed doses of prescription medications; forgone preventive and other general medical care, mental health care, and elective surgeries; forgone care for new severe health issues; and reasons for forgoing care.
Of 1468 individuals who completed wave 1 of the Johns Hopkins COVID-19 Civic Life and Public Health Survey (70.4% completion rate), 1337 completed wave 2 (91.1% completion rate). The sample of respondents included 691 (52%) women, 840 non-Hispanic White individuals (63%), 160 non-Hispanic Black individuals (12%), and 223 Hispanic individuals (17%). The mean (SE) age of respondents was 48 (0.78) years. A total of 544 respondents (41%) forwent medical care from March through mid-July 2020. Among 1055 individuals (79%) who reported needing care, 544 (52%) reported forgoing care for any reason, 307 (29%) forwent care owing to fear of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission, and 75 (7%) forwent care owing to financial concerns associated with the COVID-19 pandemic. Respondents who were unemployed, compared with those who were employed, forwent care more often (121 of 186 respondents [65%] vs 251 of 503 respondents [50%]; P = .01) and were more likely to attribute forgone care to fear of SARS-CoV-2 transmission (78 of 186 respondents [42%] vs 120 of 503 respondents [24%]; P = .002) and financial concerns (36 of 186 respondents [20%] vs 28 of 503 respondents [6%]; P = .001). Respondents lacking health insurance were more likely to attribute forgone care to financial concerns than respondents with Medicare or commercial coverage (19 of 88 respondents [22%] vs 32 of 768 respondents [4%]; P < .001). Frequency of and reasons for forgone care differed in some instances by race/ethnicity, socioeconomic status, age, and health status.
This survey study found a high frequency of forgone care among US adults from March to mid-July 2020. Policies to improve health care affordability and to reassure individuals that they can safely seek care may be necessary with surging COVID-19 case rates.
2019 年冠状病毒病（COVID-19）大流行对美国医疗体系造成了重大干扰。
估计 2020 年 3 月至 7 月中旬报告的医疗服务中断的频率和原因，并研究报告放弃医疗服务的美国成年人的特征。
设计、地点和参与者：本调查研究使用了约翰霍普金斯 COVID-19 公民生活和公共卫生调查第二波的数据，于 2020 年 7 月 7 日至 7 月 22 日进行。受访者包括美国全国性样本，即 1337 名年龄在 18 岁及以上的美国成年人，他们是国家意见研究中心 AmeriSpeak 小组的一部分。
美国 COVID-19 大流行的初始阶段，定义为 2020 年 3 月至 7 月中旬。
主要结果是错过处方剂量；放弃预防和其他一般医疗保健、心理健康保健和择期手术；因新的严重健康问题而放弃治疗；以及放弃治疗的原因。
在完成约翰霍普金斯 COVID-19 公民生活和公共卫生调查第一波（完成率为 70.4%）的 1468 名受访者中，有 1337 名完成了第二波（完成率为 91.1%）。受访者样本包括 691 名（52%）女性、840 名非西班牙裔白人（63%）、160 名非西班牙裔黑人（12%）和 223 名西班牙裔（17%）。受访者的平均（SE）年龄为 48（0.78）岁。共有 544 名受访者（41%）在 2020 年 3 月至 7 月中旬期间放弃了医疗服务。在 1055 名（79%）报告需要治疗的人中，有 544 名（52%）因任何原因放弃了治疗，307 名（29%）因担心严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）传播而放弃了治疗，75 名（7%）因与 COVID-19 大流行相关的经济问题而放弃了治疗。与就业者相比，失业者更经常放弃治疗（186 名受访者中的 121 名[65%]与 503 名受访者中的 251 名[50%]；P=0.01），并且更有可能将放弃治疗归因于对 SARS-CoV-2 传播的恐惧（186 名受访者中的 78 名[42%]与 503 名受访者中的 120 名[24%]；P=0.002）和经济问题（186 名受访者中的 36 名[20%]与 503 名受访者中的 28 名[6%]；P=0.001）。没有医疗保险的受访者比有医疗保险或商业保险的受访者更有可能将放弃治疗归因于经济问题（88 名受访者中的 19 名[22%]与 768 名受访者中的 32 名[4%]；P<0.001）。在某些情况下，放弃治疗的频率和原因因种族/族裔、社会经济地位、年龄和健康状况而异。
本调查研究发现，2020 年 3 月至 7 月中旬期间，美国成年人放弃医疗服务的频率很高。随着 COVID-19 病例数的飙升，可能需要提高医疗保健的可负担性，并让个人相信他们可以安全地寻求医疗服务，以确保政策的实施。
