Browsing by Author "Steinwandel, Mark"

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    Avoidance of Emergency Care in the Southeastern United States During the COVID-19 Pandemic
    (Oxford University Press, 2022-04-08) Gettler, Erin; Stern, Rebecca; Ni, Bin; Munro, Heather M.; Steinwandel, Mark; Aronoff, David M.; Gupta, Deepak K.; Sanderson, Maureen; Shrubsole, Martha J.; Lipworth, Loren; Medicine, School of Medicine
    In a low-income cohort in the Southeastern United States, 5% of participants avoided emergency medical care during the coronavirus disease 2019 pandemic, primarily due to fear and visitor restrictions. Younger age, self-perceived lower health status, lack of a personal doctor, and decreased income were associated with greater likelihood of deferring emergency care.
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    Disruption of medical care among individuals in the southeastern United States during the COVID-19 pandemic
    (Sage, 2021-09-24) Ni, Bin; Gettler, Erin; Stern, Rebecca; Munro, Heather M.; Steinwandel, Mark; Aldrich, Melinda C.; Friedman, Debra L.; Sanderson, Maureen; Schlundt, David; Aronoff, David M.; Gupta, Deepak K.; Shrubsole, Martha J.; Lipworth, Loren; Medicine, School of Medicine
    Background: Widespread disruptions of medical care to mitigate COVID-19 spread and reduce burden on healthcare systems may have deleterious public health consequences. Design and methods: To examine factors contributing to healthcare interruptions during the pandemic, we conducted a COVID-19 impact survey between 10/7-12/14/2020 among participants of the Southern Community Cohort Study, which primarily enrolled low-income individuals in 12 southeastern states from 2002-2009. COVID survey data were combined with baseline and follow-up data. Results: Among 4,463 respondents, 40% reported having missed/delayed a health appointment during the pandemic; the common reason was provider-initiated cancellation or delay (63%). In a multivariable model, female sex was the strongest independent predictor of interrupted care, with odds ratio (OR) 1.63 (95% confidence interval [CI] 1.40-1.89). Those with higher education (OR 1.27; 95% CI 1.05-1.54 for college graduate vs ≤high school) and household income (OR 1.47; 95% CI 1.16-1.86 for >$50,000 vs <$15,000) were at significantly increased odds of missing healthcare. Having greater perceived risk for acquiring (OR 1.42; 95% CI 1.17-1.72) or dying from COVID-19 (OR 1.25; 95% CI 1.04-1.51) also significantly increased odds of missed/delayed healthcare. Age was inversely associated with missed healthcare among men (OR for 5-year increase in age 0.88; 95% CI 0.80-0.96) but not women (OR 0.97; 95% CI 0.91-1.04; p-interaction=0.04). Neither race/ethnicity nor comorbidities were associated with interrupted healthcare. Conclusions: Disruptions to healthcare disproportionately affected women and were primarily driven by health system-initiated deferrals and individual perceptions of COVID-19 risk, rather than medical co-morbidities or other traditional barriers to healthcare access.