Division of General Medicine, University of Michigan Medical School, Ann Arbor.
Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor.
JAMA Health Forum. 2021 Jul 2;2(7):e211408. doi: 10.1001/jamahealthforum.2021.1408. eCollection 2021 Jul.
The association of the COVID-19 pandemic with women's preventive health care use is unknown.
To describe utilization of women's preventive health services.
Cross-sectional study of women aged 18 to 74 years enrolled in a commercial health maintenance organization in Michigan.
COVID-19 pandemic (2019-2020).
Adjusted odds ratios (AORs) of receiving breast cancer screening, cervical cancer screening, sexually transmitted infection (STI) screening, long-acting reversible contraception (LARC) insertions, and pharmacy-obtained contraception, adjusted for month, age, county, zip code characteristics (per-capita income, non-White percentage of population, non-English-proficient percentage of population), and plan designation (primary plan holder vs dependent).
The study population included 685 373 women aged 18 to 74 years, enrolled for 13 000 715 person-months, of whom 10 061 275 person-months (77.4%) were among women aged 25 to 64 years and 8 020 215 (61.7%) were the primary plan holder, with mean zip code per capita income of $33 708, 20.2% mean zip code non-White population, and 3.4% mean zip code non-English-speaking population. For services requiring an in-person visit (breast cancer screening, cervical cancer screening, STI testing, and LARC insertions), utilization declined by 60% to 90% during the spring of 2020, with a nadir in April 2020, after which utilization for all services recovered to close to 2019 levels by July 2020. Claims for pharmacy-obtained hormonal contraceptives in 2020 were consistently 15% to 30% lower than 2019. The AORs of a woman receiving a given preventive service in 2020 compared with 2019 were significantly lower for breast cancer screening (AOR, 0.80; 95% CI, 0.79-0.80), cervical cancer screening (AOR, 0.80; 95% CI, 0.80-0.81), STI screening (AOR, 0.83; 95% CI, 0.82-0.84), LARC insertion (AOR, 0.87; 95% CI, 0.84-0.90), and pharmacy-obtained contraception (AOR, 0.73; 95% CI, 0.72-0.74) (all < .001).
In this cross-sectional study of women enrolled in a large US commercial health maintenance organization plan, the COVID-19 pandemic was associated with large but transient declines in rates of breast cancer screening, cervical cancer screening, STI screening, and LARC insertions, and moderate persistent declines in pharmacy-obtained hormonal contraceptives. The overall odds of a woman receiving a given preventive service in 2020 was 20% to 30% lower than 2019. Further research into disparities in access to care and the health outcomes of decreased use of these key health services is warranted.
COVID-19 大流行与女性预防保健使用之间的关联尚不清楚。
描述妇女预防保健服务的使用情况。
设计、地点和参与者：横断面研究纳入了密歇根州一家商业健康维护组织中年龄在 18 至 74 岁的女性。
COVID-19 大流行（2019-2020 年）。
调整后的比值比（AOR）用于接受乳腺癌筛查、宫颈癌筛查、性传播感染（STI）筛查、长效可逆避孕（LARC）插入和药房获得的避孕，调整了月份、年龄、县、邮政编码特征（人均收入、非白人人口百分比、非英语熟练人口百分比）和计划指定（主要计划持有者与受抚养人）。
研究人群包括 685373 名年龄在 18 至 74 岁的女性，登记了 13000715 人/月，其中 10061275 人/月（77.4%）为 25 至 64 岁的女性，8020215 人/月（61.7%）为主要计划持有者，平均邮政编码人均收入为 33708 美元，20.2%的平均邮政编码非白种人人口和 3.4%的平均邮政编码非英语人口。对于需要亲自就诊的服务（乳腺癌筛查、宫颈癌筛查、STI 检测和 LARC 插入），2020 年春季的利用率下降了 60%至 90%，2020 年 4 月达到最低点，此后所有服务的利用率在 2020 年 7 月恢复到接近 2019 年的水平。2020 年药房获得的激素避孕药的索赔始终比 2019 年低 15%至 30%。与 2019 年相比，2020 年接受特定预防服务的女性的 AOR 明显降低，乳腺癌筛查（AOR，0.80；95%CI，0.79-0.80）、宫颈癌筛查（AOR，0.80；95%CI，0.80-0.81）、STI 筛查（AOR，0.83；95%CI，0.82-0.84）、LARC 插入（AOR，0.87；95%CI，0.84-0.90）和药房获得的避孕（AOR，0.73；95%CI，0.72-0.74）（均<0.001）。
在这项对美国大型商业健康维护组织计划中登记的女性进行的横断面研究中，COVID-19 大流行与乳腺癌筛查、宫颈癌筛查、STI 筛查和 LARC 插入率的大幅但短暂下降以及药房获得的激素避孕药中度持续下降有关。2020 年接受特定预防服务的女性总体几率比 2019 年低 20%至 30%。需要进一步研究获得护理的差异以及这些关键健康服务使用率下降对健康结果的影响。
Zotero 插件