27.6% of kids missed or delayed preventive care during COVID-19 pandemic

Key takeaways:

• The percentage of children with missed or delayed care varied by race and ethnicity.
• In the event of a future pandemic, an expert said clinics could consider telehealth or drive-through vaccine administration.

More than one-fourth of children in the United States had delayed or missed preventive care due to the COVID-19 pandemic, according to a recent study published in JAMA Network Open.

“Preventive care access and utilization is an important determinant of health outcomes,” Maya Tabet, PhD, MS, an assistant professor of  epidemiology at the University of Health Sciences and Pharmacy in St. Louis, told Healio. “Children need regular well-child visits to track their development, get routine immunizations, promote healthy behaviors, and identify any problems.”

Previous research has shown that pediatric care declined during the pandemic — with national vaccination coverage dropping from 95% to below 94% for kindergarten children during the 2020-2021 school year. However, “evidence from national data on the extent to which preventive care has been affected and the risk factors associated with missed preventive care due to the pandemic was lacking,” Tabet said.

So, the researchers conducted a cross-sectional study to identify potential risk factors and interventions for certain demographic groups using data from the 2021 National Survey of Children’s Health on 50,892 youth aged 0 to 17 years. Among the cohort, 48.9% were girls, 50.1% were non-Hispanic white children and the mean age was 8 years.

Parents and caregivers were asked if the child had skipped, missed or delayed a preventive care visit during the last 12 months due to the pandemic. The researchers also evaluated:

• predisposing factors, including age and gender;
• enabling factors, including household income and home ownership; and
• needs factors, including the child’s perceived health and health conditions.

Tabet and colleagues found that 27.6% of youth had missed or delayed preventive care. The findings varied by race and ethnicity, with multiracial children having the highest percentage at 32.1%.

Compared with non-Hispanic white children, Hispanic children (prevalence ratio [PR] = 1.19; 95% CI, 1.09-1.31), Asian or Pacific Islander children (PR = 1.16; 95% CI, 1.02-1.32) and multiracial children (PR = 1.23; 95% CI, 1.11-1.37) were all more likely to experience missed or delayed care.

In analyses stratified by race and ethnicity, associated risk factors for missed or delayed care among non-Hispanic Black children included being aged 6 to 8 years (PR = 1.9; 95% CI, 1.23-2.92) and having difficulty covering basic needs sometimes or often (PR = 1.68; 95% CI, 1.35-2.09). Meanwhile, older age was an associated risk factor in multiracial (PR = 1.73; 95% CI, 1.16-2.57) and non-Hispanic white children (PR = 2.05; 95% CI, 1.78-2.37), with those aged 9 to 11 years more likely to miss care.

“Our finding that older children were more likely to have delayed or missed preventive care is consistent with previous research and may reflect caregiver prioritization of well-child visits, during which vaccinations are typically administered,” the researchers wrote.

For non-Hispanic white children, a household of four or more children, fair or poor health and two or more health conditions were all risk factors.

Tabet said that in the event of future pandemics, “clinics may consider using alternate health care delivery models such as telehealth or drive-through administration of vaccines to ensure continuity of care.”

“Also, programs and policies addressing financial barriers are warranted, as having difficulty covering basic needs such as food and housing was associated with increased likelihood of delayed or missed pediatric preventive care,” she said.

Despite both the U.S. and WHO ending their COVID-19 pandemic-related declarations of public health emergencies this past spring, Tabet highlighted several efforts that are still needed to support consistent preventive care.

“We need to continue to examine trends in health care use; develop strategies to promote catch-up visits, particularly among high-risk groups; and address barriers to health care use during times of pandemic and beyond,” she said.