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Unmet health care needs during the COVID-19 pandemic among adults: a prospective cohort study in the Canadian Longitudinal Study on Aging

Jayati Khattar, Laura N. Anderson, Vanessa De Rubeis, Margaret de Groh, Ying Jiang, Aaron Jones, Nicole E. Basta, Susan Kirkland, Christina Wolfson, Lauren E. Griffith and Parminder Raina; for the Canadian Longitudinal Study on Aging (CLSA) Team
February 14, 2023 11 (1) E140-E151; DOI: https://doi.org/10.9778/cmajo.20210320
Jayati Khattar
Department of Health Research Methods, Evidence, and Impact (Khattar, Anderson, De Rubeis, Jones, Griffith, Raina), McMaster University, Hamilton, Ont.; Applied Research Division (de Groh, Jiang), Center for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Department of Epidemiology, Biostatistics and Occupational Health (Basta, Wolfson), School of Population and Global Health, McGill University, Montréal, Que.; Department of Community Health and Epidemiology and Division of Geriatric Medicine (Kirkland), Dalhousie University, Halifax, NS
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Laura N. Anderson
Department of Health Research Methods, Evidence, and Impact (Khattar, Anderson, De Rubeis, Jones, Griffith, Raina), McMaster University, Hamilton, Ont.; Applied Research Division (de Groh, Jiang), Center for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Department of Epidemiology, Biostatistics and Occupational Health (Basta, Wolfson), School of Population and Global Health, McGill University, Montréal, Que.; Department of Community Health and Epidemiology and Division of Geriatric Medicine (Kirkland), Dalhousie University, Halifax, NS
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Vanessa De Rubeis
Department of Health Research Methods, Evidence, and Impact (Khattar, Anderson, De Rubeis, Jones, Griffith, Raina), McMaster University, Hamilton, Ont.; Applied Research Division (de Groh, Jiang), Center for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Department of Epidemiology, Biostatistics and Occupational Health (Basta, Wolfson), School of Population and Global Health, McGill University, Montréal, Que.; Department of Community Health and Epidemiology and Division of Geriatric Medicine (Kirkland), Dalhousie University, Halifax, NS
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Margaret de Groh
Department of Health Research Methods, Evidence, and Impact (Khattar, Anderson, De Rubeis, Jones, Griffith, Raina), McMaster University, Hamilton, Ont.; Applied Research Division (de Groh, Jiang), Center for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Department of Epidemiology, Biostatistics and Occupational Health (Basta, Wolfson), School of Population and Global Health, McGill University, Montréal, Que.; Department of Community Health and Epidemiology and Division of Geriatric Medicine (Kirkland), Dalhousie University, Halifax, NS
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Ying Jiang
Department of Health Research Methods, Evidence, and Impact (Khattar, Anderson, De Rubeis, Jones, Griffith, Raina), McMaster University, Hamilton, Ont.; Applied Research Division (de Groh, Jiang), Center for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Department of Epidemiology, Biostatistics and Occupational Health (Basta, Wolfson), School of Population and Global Health, McGill University, Montréal, Que.; Department of Community Health and Epidemiology and Division of Geriatric Medicine (Kirkland), Dalhousie University, Halifax, NS
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Aaron Jones
Department of Health Research Methods, Evidence, and Impact (Khattar, Anderson, De Rubeis, Jones, Griffith, Raina), McMaster University, Hamilton, Ont.; Applied Research Division (de Groh, Jiang), Center for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Department of Epidemiology, Biostatistics and Occupational Health (Basta, Wolfson), School of Population and Global Health, McGill University, Montréal, Que.; Department of Community Health and Epidemiology and Division of Geriatric Medicine (Kirkland), Dalhousie University, Halifax, NS
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Nicole E. Basta
Department of Health Research Methods, Evidence, and Impact (Khattar, Anderson, De Rubeis, Jones, Griffith, Raina), McMaster University, Hamilton, Ont.; Applied Research Division (de Groh, Jiang), Center for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Department of Epidemiology, Biostatistics and Occupational Health (Basta, Wolfson), School of Population and Global Health, McGill University, Montréal, Que.; Department of Community Health and Epidemiology and Division of Geriatric Medicine (Kirkland), Dalhousie University, Halifax, NS
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Susan Kirkland
Department of Health Research Methods, Evidence, and Impact (Khattar, Anderson, De Rubeis, Jones, Griffith, Raina), McMaster University, Hamilton, Ont.; Applied Research Division (de Groh, Jiang), Center for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Department of Epidemiology, Biostatistics and Occupational Health (Basta, Wolfson), School of Population and Global Health, McGill University, Montréal, Que.; Department of Community Health and Epidemiology and Division of Geriatric Medicine (Kirkland), Dalhousie University, Halifax, NS
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Christina Wolfson
Department of Health Research Methods, Evidence, and Impact (Khattar, Anderson, De Rubeis, Jones, Griffith, Raina), McMaster University, Hamilton, Ont.; Applied Research Division (de Groh, Jiang), Center for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Department of Epidemiology, Biostatistics and Occupational Health (Basta, Wolfson), School of Population and Global Health, McGill University, Montréal, Que.; Department of Community Health and Epidemiology and Division of Geriatric Medicine (Kirkland), Dalhousie University, Halifax, NS
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Lauren E. Griffith
Department of Health Research Methods, Evidence, and Impact (Khattar, Anderson, De Rubeis, Jones, Griffith, Raina), McMaster University, Hamilton, Ont.; Applied Research Division (de Groh, Jiang), Center for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Department of Epidemiology, Biostatistics and Occupational Health (Basta, Wolfson), School of Population and Global Health, McGill University, Montréal, Que.; Department of Community Health and Epidemiology and Division of Geriatric Medicine (Kirkland), Dalhousie University, Halifax, NS
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Parminder Raina
Department of Health Research Methods, Evidence, and Impact (Khattar, Anderson, De Rubeis, Jones, Griffith, Raina), McMaster University, Hamilton, Ont.; Applied Research Division (de Groh, Jiang), Center for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Department of Epidemiology, Biostatistics and Occupational Health (Basta, Wolfson), School of Population and Global Health, McGill University, Montréal, Que.; Department of Community Health and Epidemiology and Division of Geriatric Medicine (Kirkland), Dalhousie University, Halifax, NS
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  • Figure 1:
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    Figure 1:

    Canadian Longitudinal Study on Aging participant flow throughout baseline (2011–2015), first follow-up (2015–2018) and COVID-19 (2020) data collection. Note: CLSA = Canadian Longitudinal Study on Aging.

  • Figure 2:
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    Figure 2:

    Prevalence of any challenges in accessing health care during the COVID-19 pandemic as reported by participants during the Canadian Longitudinal Study on Aging COVID-19 exit survey (September–December 2020), according to select sociodemographic characteristics. Note: CI = confidence interval.

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    Figure 3:

    Prevalence of not visiting the hospital or seeing a doctor while needing to during the COVID-19 pandemic as reported by participants during the Canadian Longitudinal Study on Aging COVID-19 exit survey (September–December 2020), according to select sociodemographic characteristics. Note: CI = confidence interval.

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    Figure 4:

    Prevalence of barriers to accessing testing for SARS-CoV-2 infection during the COVID-19 pandemic as reported by participants during the Canadian Longitudinal Study on Aging COVID-19 exit survey (September–December 2020), according to select sociodemographic characteristics. Note: CI = confidence interval.

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    Figure 5:

    Reasons for not visiting the hospital or seeing a doctor while needing to as reported by participants in the Canadian Longitudinal Study on Aging COVID-19 exit survey (September–December 2020), stratified by age (n = 1731).

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    Figure 6:

    Barriers to accessing testing for SARS-CoV-2 infection as reported by participants in the Canadian Longitudinal Study on Aging COVID-19 exit survey (September–December 2020), stratified by age (n = 914).

Tables

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    Table 1:

    Descriptive characteristics of CLSA participants who completed the COVID-19 exit survey (September–December 2020)

    CharacteristicNo. (%) of participants
    n = 23 972
    Measured at baseline (2011–2015)
    Sex
     Female12743 (53.2)
     Male11229 (46.8)
    Racial background
     White23273 (97.2)
     Not white673 (2.8)
     Missing26
    Immigrant status
     Immigrant3789 (15.8)
     Nonimmigrant20173 (84.2)
     Missing10
    Education
     < Secondary school1101 (4.6)
     Secondary school2349 (9.8)
     Some postsecondary1719 (7.2)
     Postsecondary degree or diploma18756 (78.4)
     Missing47
    Measured at first follow-up (2015–2018)
    Household income, $
     < 20 000861 (3.8)
     20 000–49 9994855 (21.4)
     50 000–99 9998569 (37.9)
     100 000–149 9994589 (20.3)
     ≥ 150 0003758 (16.6)
     Missing1340
    Marital status
     Single, never married or never lived with a partner2007 (8.4)
     Married or living with a partner16833 (70.3)
     Widowed2332 (9.7)
     Divorced or separated2785 (11.6)
     Missing15
    Unmet needs (prepandemic)
     Yes1874 (7.8)
     No22060 (92.2)
     Missing38
    Measured at COVID-19 baseline (April–May 2020)
    Age, yr
     < 500 (0.0)
     50–541097 (4.6)
     55–647250 (30.2)
     65–748759 (36.5)
     75–845145 (21.5)
     85–961721 (7.2)
    Region*
     Atlantic4334 (18.0)
     Prairies5130 (21.4)
     Ontario5554 (23.2)
     Quebec4336 (18.1)
     British Columbia4618 (19.3)
    Urban or rural
     Rural area4245 (17.8)
     Urban area19 602 (82.2)
     Missing125
    Dwelling type
     House18625 (77.8)
     Apartment or condominium4410 (18.4)
     Other907 (3.8)
     Missing30
    Chronic conditions
     Present14 235 (59.7)
     Absent9594 (40.3)
     Missing143
    Work status
     Usually work outside the home6273 (26.6)
     Do not work outside the home17 357 (73.4)
     Missing342
    Measured at COVID-19 exit survey (September–December 2020)
    Any challenges in accessing health care
     Yes5992 (25.3)
     No17 759 (74.7)
     Missing221
    Did not go to the hospital or to see a doctor even though they needed to
     Yes1776 (7.5)
     No21989 (92.5)
     Missing207
    Experienced barriers to accessing testing for COVID-19
     Yes917 (3.9)
     No22828 (96.1)
     Missing227
    • Note: CLSA = Canadian Longitudinal Study on Aging.

    • ↵* Atlantic: Newfoundland and Labrador, Nova Scotia, Prince Edward Island, New Brunswick; Prairies: Alberta, Saskatchewan, Manitoba.

    • View popup
    Table 2:

    Logistic regression models assessing the association between sociodemographic characteristics and unmet health care needs during the COVID-19 pandemic as reported by participants during the CLSA COVID-19 exit survey (September–December 2020)

    CharacteristicOR (95% CI)
    Any challenges in accessing health careDid not go to the hospital or to see a doctor even though they needed toExperienced barriers to accessing testing for SARS-CoV-2
    Sex
     MaleRef.Ref.Ref.
     Female1.01 (0.95–1.07)1.20 (1.09–1.32)0.92 (0.80–1.05)
    Age, yr
     50–55Ref.Ref.Ref.
     55–640.88 (0.77–1.02)0.78 (0.63–0.97)0.72 (0.55–0.94)
     65–740.88 (0.77–1.02)0.74 (0.60–0.91)0.59 (0.45–0.77)
     75–840.73 (0.63–0.85)0.59 (0.47–0.74)0.45 (0.34–0.60)
     85–960.52 (0.43–0.62)0.51 (0.36–0.68)0.37 (0.25–0.55)
    Region
     AtlanticRef.Ref.Ref.
     Quebec0.48 (0.43–0.54)1.38 (1.19–1.61)0.80 (0.58–1.10)
     Ontario1.22 (1.11–1.33)0.97 (0.83–1.13)3.40 (2.68–4.32)
     Prairies0.73 (0.67–0.80)0.74 (0.63–0.87)1.92 (1.48–2.48)
     British Columbia1.03 (0.94–1.13)0.92 (0.79–1.08)2.37 (1.84–3.06)
    Urban or rural
     UrbanRef.Ref.Ref.
     Rural0.93 (0.86–1.00)1.06 (0.93–1.20)0.79 (0.65–0.95)
    Racial background
     WhiteRef.Ref.Ref.
     Not white0.91 (0.76–1.10)1.37 (1.06–1.78)1.09 (0.74–1.60)
    Immigrant status
     NonimmigrantRef.Ref.Ref.
     Immigrant1.18 (1.09–1.27)1.26 (1.11–1.43)1.15 (0.97–1.37)
    Household income, $
     < 20 0000.81 (0.68–0.97)1.52 (1.18–1.97)0.66 (0.46–0.97)
     20 000–49 9990.80 (0.73–0.89)1.19 (1.01–1.40)0.56 (0.45–0.69)
     50 000–99 9990.89 (0.82–0.98)1.03 (0.89–1.20)0.56 (0.47–0.68)
     100 000–149 9991.03 (0.93–1.13)1.05 (0.89–1.24)0.68 (0.56–0.83)
     ≥ 150 000Ref.Ref.Ref.
    Education
     < Secondary school0.58 (0.50–0.69)1.02 (0.81–1.29)0.54 (0.36–0.81)
     Secondary school0.74 (0.66–0.82)0.96 (0.81–1.14)0.52 (0.39–0.67)
     Some postsecondary1.02 (0.91–1.14)1.09 (0.90–1.30)0.90 (0.70–1.16)
     ≥ Postsecondary diplomaRef.Ref.Ref.
    Marital status
     Married or living with a partnerRef.Ref.Ref.
     Single, never married or never lived with a partner1.02 (0.92–1.14)1.16 (0.98–1.38)1.15 (0.92–1.45)
     Widowed0.76 (0.70–0.84)1.02 (0.87–1.21)0.72 (0.56–0.94)
     Divorced or separated1.03 (0.94–1.13)1.40 (1.21–1.61)1.13 (0.92–1.38)
    Chronic conditions
     AbsentRef.Ref.Ref.
     Present1.35 (1.27–1.43)1.45 (1.31–1.61)0.97 (0.85–1.11)
    Dwelling type
     HouseRef.Ref.Ref.
     Apartment0.90 (0.83–0.97)1.09 (0.97–1.23)1.01 (0.85–1.19)
     Other0.74 (0.63–0.88)1.08 (0.84–1.38)0.59 (0.38–0.92)
    Work status
     Do not work outside the homeRef.Ref.Ref.
     Usually work outside the home1.07 (1.01–1.15)1.05 (0.94–1.17)1.43 (1.24–1.65)
    Unmet needs (prepandemic)
     Yes2.21 (2.00–2.44)2.91 (2.55–3.33)1.77 (1.45–2.16)
     NoRef.Ref.Ref.
    • Note: CI = confidence interval, OR = odds ratio, Ref. = reference category.

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Unmet health care needs during the COVID-19 pandemic among adults: a prospective cohort study in the Canadian Longitudinal Study on Aging
Jayati Khattar, Laura N. Anderson, Vanessa De Rubeis, Margaret de Groh, Ying Jiang, Aaron Jones, Nicole E. Basta, Susan Kirkland, Christina Wolfson, Lauren E. Griffith, Parminder Raina
Jan 2023, 11 (1) E140-E151; DOI: 10.9778/cmajo.20210320

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Unmet health care needs during the COVID-19 pandemic among adults: a prospective cohort study in the Canadian Longitudinal Study on Aging
Jayati Khattar, Laura N. Anderson, Vanessa De Rubeis, Margaret de Groh, Ying Jiang, Aaron Jones, Nicole E. Basta, Susan Kirkland, Christina Wolfson, Lauren E. Griffith, Parminder Raina
Jan 2023, 11 (1) E140-E151; DOI: 10.9778/cmajo.20210320
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