Department of Epidemiology and Department of Neurology, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, the Netherlands.
Department of Epidemiology and Department of General Practice, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, the Netherlands.
Br J Gen Pract. 2024 Oct 31;74(748):e791-e796. doi: 10.3399/BJGP.2023.0637. Print 2024 Nov.
During the COVID-19 pandemic, global trends of reduced healthcare-seeking behaviour were observed. This raises concerns about the consequences of healthcare avoidance for population health.
To determine the association between healthcare avoidance during the early stages of the COVID-19 pandemic and all-cause mortality.
This was a 32-month follow-up within the population-based Rotterdam Study, after sending a COVID-19 questionnaire at the onset of the pandemic in April 2020 to all communty dwelling participants ( = 6241/8732, response rate 71.5%).
Cox proportional hazards models assessed the risk of all-cause mortality among respondents who avoided health care because of the COVID-19 pandemic. Mortality status was collected through municipality registries and medical records.
Of 5656 respondents, one-fifth avoided health care because of the COVID-19 pandemic ( = 1143). Compared with non-avoiders, those who avoided health care more often reported symptoms of depression ( = 357, 31.2% versus = 554, 12.3%) and anxiety ( = 340, 29.7% versus = 549, 12.2%), and more often rated their health as poor to fair ( = 336, 29.4% versus = 457, 10.1%) . Those who avoided health care had an increased adjusted risk of all-cause mortality (hazard ratio [HR] 1.30, 95% confidence interval [CI] = 1.01 to 1.67), which remained nearly identical after adjustment for history of any non-communicable disease (HR 1.20, 95% CI = 0.93 to 1.54). However, this association attenuated after additional adjustment for mental and physical self-perceived health factors (HR 0.93, 95% CI = 0.71 to 1.20).
This study found an increased risk of all-cause mortality among individuals who avoided health care during COVID-19. These individuals were characterised by poor mental and physical self-perceived health. Therefore, interventions should be targeted to these vulnerable individuals to safeguard their access to primary and specialist care to limit health disparities, inside and beyond healthcare crises.
在 COVID-19 大流行期间，观察到全球医疗保健寻求行为减少的趋势。这引发了对避免医疗保健对人群健康的后果的担忧。
确定 COVID-19 大流行早期阶段避免医疗保健与全因死亡率之间的关联。
这是在人群基础的鹿特丹研究中的 32 个月随访，在 2020 年 4 月大流行开始时向所有社区居住的参与者发送 COVID-19 问卷（=6241/8732，响应率为 71.5%）。
使用 Cox 比例风险模型评估了因 COVID-19 而避免医疗保健的受访者的全因死亡率风险。通过市登记处和医疗记录收集死亡率状况。
在 5656 名受访者中，五分之一的人因 COVID-19 而避免医疗保健（=1143）。与非回避者相比，那些更频繁地回避医疗保健的人报告有抑郁症状（=357，31.2%对=554，12.3%）和焦虑症状（=340，29.7%对=549，12.2%），并且更频繁地将自己的健康评为差到一般（=336，29.4%对=457，10.1%）。那些回避医疗保健的人全因死亡率的调整后风险增加（危险比[HR]1.30，95%置信区间[CI]=1.01 至 1.67），在调整任何非传染性疾病史后几乎保持不变（HR 1.20，95%CI=0.93 至 1.54）。然而，在进一步调整心理和身体自我感知健康因素后，这种关联减弱（HR 0.93，95%CI=0.71 至 1.20）。
本研究发现，在 COVID-19 期间避免医疗保健的个体全因死亡率风险增加。这些个体的心理和身体自我感知健康状况较差。因此，应针对这些弱势群体进行干预，以确保他们获得初级和专科保健，以限制医疗保健危机内外的健康差距。
