Doctoral School of Health Sciences, University of Debrecen, 4028 Debrecen, Hungary.
Department of Public Health, College of Health Sciences, Mizan Tepi University, Mizan Aman 260, Ethiopia.
Int J Environ Res Public Health. 2022 Feb 16;19(4):2258. doi: 10.3390/ijerph19042258.
The social representation of restricted health care use during the COVID-19 pandemic has not been evaluated properly yet in Hungary.
Our study aimed to quantify the effect of COVID-19 pandemic measures on general practitioner (GP) visits, specialist care, hospitalization, and cost-related prescription nonredemption (CRPNR) among adults, and to identify the social strata susceptible to the pandemic effect.
This cross-sectional study was based on nationally representative data of 6611 (N = 5603 and N = 1008) adults. Multivariable logistic regression models were applied to determine the sociodemographic and clinical factors influencing health care use by odds ratios (ORs) along with the corresponding 95% confidence intervals (CI). To identify the social strata susceptible to the pandemic effect, the interaction of the time of data collection with the level of education, marital status, and Roma ethnicity, was tested and described by iORs.
While the CRPNR did not change, the frequency of GP visits, specialist care, and hospitalization rates was remarkably reduced by 22.2%, 26.4%, and 6.7%, respectively, during the pandemic. Roma proved to be not specifically affected by the pandemic in any studied aspect, and the pandemic restructuring of health care impacted the social subgroups evenly with respect to hospital care. However, the pandemic effect was weaker among primary educated adults (iOR = 0.434; 95% CI 0.243-0.776, OR = 0.598; 95% CI 0.364-0.985), and stronger among married adults (iOR = 2.284; 95% CI 1.043-4.998, iOR = 1.915; 95% CI 1.157-3.168), on the frequency of GP visits and specialist visits. The prepandemic CRPNR inequality by the level of education was increased (iOR = 0.236; 95% CI 0.075-0.743).
Primary educated and widowed adults did not follow the general trend, and their prepandemic health care use was not reduced during the pandemic. This shows that although the management of pandemic health care use restrictions was implemented by not increasing social inequity, the drug availability for primary educated individuals could require more support.
在匈牙利，COVID-19 大流行期间对限制医疗保健使用的社会代表性尚未得到适当评估。
我们的研究旨在定量评估 COVID-19 大流行措施对成年人普通医生（GP）就诊、专科护理、住院和与费用相关的处方不兑现（CRPNR）的影响，并确定易受大流行影响的社会阶层。
这是一项基于全国代表性数据的横断面研究，共纳入 6611 名成年人（N=5603 和 N=1008）。采用多变量逻辑回归模型，通过比值比（OR）及其相应的 95%置信区间（CI），确定影响医疗保健使用的社会人口学和临床因素。为了确定易受大流行影响的社会阶层，我们测试并通过比值比（iOR）描述了数据收集时间与教育水平、婚姻状况和罗姆族裔之间的交互作用。
尽管 CRPNR 没有变化，但大流行期间 GP 就诊、专科护理和住院率分别显著下降 22.2%、26.4%和 6.7%。罗姆族在任何研究方面都没有受到大流行的特别影响，医疗保健的大流行重组对住院护理的社会亚组产生了均匀的影响。然而，大流行对受教育程度较低的成年人（iOR=0.434；95%CI 0.243-0.776，OR=0.598；95%CI 0.364-0.985）的影响较弱，对已婚成年人（iOR=2.284；95%CI 1.043-4.998，iOR=1.915；95%CI 1.157-3.168）的影响较强，这体现在 GP 就诊和专科就诊的频率上。大流行前 CRPNR 不平等程度按教育水平增加（iOR=0.236；95%CI 0.075-0.743）。
受教育程度较低的成年人和丧偶成年人并未遵循总体趋势，他们在大流行期间的医疗保健使用并未减少。这表明，尽管实施了大流行医疗保健使用限制的管理，并未增加社会不平等，但为受教育程度较低的个人提供药物可能需要更多的支持。
