COVID-19 Associated Changes in Pediatric Preventive Care Utilization Public
Chen, Min-Hsuan (Spring 2023)
Abstract
Prior studies examining how the COVID-19 pandemic affects children’s health and well-being showed that pediatric preventive care use had dropped significantly since the onset of the pandemic. Research incorporating full year post-COVID data is needed to compare the health services utilization among children. Furthermore, little is known about how the pandemic affects healthcare disparities among children. To fill this knowledge gap, we used 2019 (pre-COVID) and 2021 (post-COVID) data from the National Survey of Children’s Health to examine (1) whether there are differences in the children’s receipt of any preventive care visits during the past 12 months pre vs. post the COVID-19 pandemic and (2) whether such differences vary by household income among children ages ≤17 years. Multiple logistic regressions were used to estimate any receipt of preventive visits in the past year, adjusting for demographics (sex, race, family structure, primary household language, and number of children at home), enabling characteristics (parental education, parental employment, and insurance type), and need characteristics (usual source of preventive care, parental perceived child’s health, and child’s health conditions). Post (vs. pre) COVID, we observed a reduction in the likelihood of having any preventive visits of 2.9 percentage points (ppt) (95% CI: 1.0-4.9, p = .003) among children aged 0-4, 6.3 ppt (95% CI: 4.0-8.5 p < .001) among those aged 5-10 years, and 9.7 ppt (95% CI: 7.5-11.9, p < .001) among adolescents aged 11-17 years. When stratified by age and household income, the COVID-associated reduction was significantly larger in adolescents with family income ≤138% Federal Poverty Level (p = .039, [FPL]) or 139-399% FPL (p = .007) as compared to adolescents with family income ≥ 400% FPL. This pattern was not seen among younger groups. Future studies using qualitative data are needed to fully understand the changes in pediatric preventive care utilization and how these changes affect child health outcomes during the COVID-19 pandemic. Our findings provide important implications to strategies that aim to improve pediatric preventive healthcare utilization and promote children’s health and well-being.
Table of Contents
Table of Contents
Chapter 1 Introduction ............................................................................................................... 1
2.1 Trends of Pediatric Preventive Care Visits ...................................................................... 5
2.2 Factors Influencing Pediatric Preventive Care Visits ...................................................... 6
2.3 Family Income And Pediatric Preventive Care Visits ..................................................... 7
2.4 Gaps filled and Policy Implications ................................................................................. 9
2.5 Conceptual Model .......................................................................................................... 10
2.6 Research Objectives ....................................................................................................... 16
Chapter 3 Methodology ........................................................................................................... 17
3.1 Study Design .................................................................................................................. 17
3.2 Hypotheses ..................................................................................................................... 17
3.3 Data Sources ................................................................................................................... 18
3.4 Analytic Sample Derivation ........................................................................................... 19
3.5 Measurement .................................................................................................................. 20
3.6 Data Analysis ................................................................................................................. 26
Chapter 4 Results ..................................................................................................................... 27
4.1 Bivariate Analyses.......................................................................................................... 27
4.2 Regression Analyses ...................................................................................................... 31
Chapter 5 Discussion ............................................................................................................... 37
5.1 Summary of Findings ..................................................................................................... 37
5.2 Study Limitations ........................................................................................................... 40
5.3 Clinical and Policy Implications .................................................................................... 41
5.4 Recommendations for Future Research ......................................................................... 42
5.5 Conclusions .................................................................................................................... 42
References ..................................................................................................................................... 44
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