Department of Sociology and Gerontology, Miami University, Oxford, Ohio, USA.
National Centre for Epidemiology & Population Health, The Australian National University, Canberra, ACT, Australia
BMJ Open. 2022 Feb 3;12(2):e056342. doi: 10.1136/bmjopen-2021-056342.
COVID-19 has greatly impacted older adults with pre-existing noncommunicable conditions (hereafter called pre-existing conditions) in terms of their access to essential healthcare services. Based on the theory of vertical health equity, this study investigated access to healthcare by Nepali older adults with pre-existing conditions during the COVID-19 pandemic.
A cross-sectional study surveyed 847 randomly selected older adults (≥60 years) in three districts of eastern Nepal. Survey questionnaires, administered by trained community health workers, collected information on participants reported difficulty obtaining routine care and medications during the pandemic, in addition to questions on demographics, socioeconomic factors and pre-existing conditions. Cumulative scores for pre-existing conditions were recoded as no pre-existing condition, single condition and multimorbidity for the analyses. χ tests and binary logistic regressions determined inferences.
Nearly two-thirds of the participants had a pre-existing condition (43.8% single condition and 22.8% multimorbid) and reported experiencing difficulty obtaining routine care (52.8%) and medications (13.5%). Participants with single (OR 3.06, 95% CI 2.17 to 4.32) and multimorbid (OR 5.62, 95% CI 3.63 to 8.71) conditions had threefold and fivefold increased odds of experiencing difficulty accessing routine care. Findings were similar for difficulty obtaining medication (OR single: 3.12, 95% CI 1.71 to 5.69; OR multimorbid: 3.98, 95% CI 2.01 to 7.87) where odds were greater than threefolds.
Older adults with pre-existing conditions in Nepal, who require routine medical care and medication, faced significant difficulties obtaining them during the pandemic, which may lead to deterioration in their pre-existing conditions. Public health emergency preparedness should incorporate plans for both managing the emergency and providing continuing care.
COVID-19 极大地影响了患有既往非传染性疾病（以下简称既往疾病）的老年人获得基本医疗服务的机会。基于垂直卫生公平理论，本研究调查了 COVID-19 大流行期间尼泊尔患有既往疾病的老年人获得医疗保健的情况。
一项横断面研究调查了尼泊尔东部三个地区的 847 名随机选择的老年人（≥60 岁）。由经过培训的社区卫生工作者管理的调查问卷收集了参与者在大流行期间报告获得常规护理和药物困难的信息，以及人口统计学、社会经济因素和既往疾病的问题。既往疾病的累积分数被重新编码为没有既往疾病、单一疾病和多种疾病，用于分析。 χ 检验和二元逻辑回归确定了推断。
近三分之二的参与者患有既往疾病（43.8%为单一疾病，22.8%为多种疾病），并报告在获得常规护理（52.8%）和药物（13.5%）方面存在困难。患有单一疾病（OR 3.06，95%CI 2.17 至 4.32）和多种疾病（OR 5.62，95%CI 3.63 至 8.71）的参与者获得常规护理的困难的可能性增加了两倍和五倍。在获得药物方面也有类似的发现（OR 单一：3.12，95%CI 1.71 至 5.69；OR 多种：3.98，95%CI 2.01 至 7.87），这些可能性增加了三倍以上。
尼泊尔患有既往疾病的老年人需要常规医疗和药物治疗，在大流行期间获得这些治疗的难度很大，这可能导致其既往疾病恶化。公共卫生应急准备应纳入管理紧急情况和提供持续护理的计划。
