Determinants of worse care for non-COVID-19 health or disability needs in Australia in the first month of COVID-19 restrictions: A national survey.

Abstract

We examined the effect of person-related factors on capacity to obtain needed healthcare for non-COVID-19 health conditions/disabilities under COVID-19 restrictions. This was an anonymous online survey of Australian residents ≥18years (3rd April to 2nd May 2020). We determined the ability to obtain care needed for non-COVID-19 health conditions/disabilities, experience of COVID-19, COVID-19 restrictions and sociodemographic characteristics using study-specific questions; and clinically significant depressive and anxiety symptoms using Patient Health Questionnaire 9 and Generalised Anxiety Disorder Scale 7 respectively. We calculated the population attributable fraction (PAF) to determine the proportion of worse access to non-COVID-19 health/disability care attributable to independent risk factors. 13,829 (91.5%) participants had complete data. 6,712 (46.4%) identified a need for healthcare/disability services (<45years 42.1%, ≥45years 50.3%). 31.6% aged <45years and 24.3% aged ≥45years reported worse access to health/disability care than experienced prior to the pandemic. In those aged <45years the PAF was highest for depressive symptoms (21.4%; 95% CI 12.6%-29.3%) and anxiety (PAF 19.9%, 12.3%-26.9%). with a PAF of 49.6% (40.1%-57.6%) if any one of the following was being experienced: doing unpaid work; being a student; depressive symptoms; symptoms of anxiety; experiencing high adverse impact of COVID-19 restrictions. In those ≥45years, PAF was highest for having depressive symptoms (PAF 20.9%, 16.6-24.8) with a PAF of 44.1% (36.0%-51.2%) if any one of the following was being experienced: depressive symptoms; symptoms of anxiety; doing unpaid work; living alone; being in lowest socioeconomic quintile; main source of income from government benefits; any personal experience of COVID-19. The identified risk factors, which include many that characterise those with worse health outcomes generally, explained 44%-50% of worse access to necessary health/disability care. These data have the potential to inform targeted strategies aimed at reducing a post-pandemic escalation of poor health outcomes, especially in vulnerable populations.