Healthcare utilization among older Brazilians during the COVID-19 pandemic: The Brazilian Longitudinal Study of Ageing-COVID-19 initiative.

Abstract

As the COVID-19 pandemic progresses, understanding its sustained impact on healthcare access and utilization represents a vital task for decision-makers and health systems. This study investigates how three aspects of health care utilization (i.e., consultations for COVID-19 related symptoms, cancelation of previously scheduled care and hospitalisation in the past 30days) relate to individual and municipal factors in a nationally-representative sample of Brazilians aged 50 and over. Data were obtained for 6584 participants from the second wave of the Brazilian Longitudinal Study of Ageing (ELSI-Brazil in Portuguese) who were administered supplemental telephone interviews between September and October 2020. Descriptive statistics, bivariate analysis and multivariate analysis using survey-weighted Poisson regression were applied to evaluate all three outcomes of interest (consultation, care cancelation, and hospitalisation). Predicted probabilities were also calculated to understand the overall effect of relevant covariates. Women were 76% less likely to seek care for COVID-19 symptoms (Odds Ratio [OR]=0.24, 95% Confidence Interval [CI]=0.10, 0.53) and 82% more likely to have healthcare cancelled due to the pandemic (OR=1.82, 95% CI=1.43, 2.33) than men. Those who live in municipalities with low coverage (<40%) of community-based primary care (the Family Health Strategy) were more likely (OR=1.80, 95% CI=1.00, 3.22) to be hospitalised for any reason in the past 30days and more likely to experience healthcare cancelation (OR=1.43, 95% CI=1.01, 2.02). Living in the Southeast and Midwest regions was associated with 62% and 78%, respectively, lower odds of previously scheduled care being cancelled due to the pandemic, in comparison to the North region (OR=0.38, 95% CI=0.21, 0.67, and OR=0.22, 95% CI=0.14, 0.36). Living in the Southeast region was associated with over 7.61 higher odds of having sought care for COVID-19-related symptoms, relative to those living in the North (OR=7.61, 95% CI=2.16, 26.85). Results highlight the uneven impact of the COVID-19 pandemic on health care utilization between males and females, and across Brazilian municipalities and regions.