There has been limited study of how the COVID-19 pandemic has affected women's health care access. Our study aims to examine the prevalence and correlates of COVID-19-related disruptions to (1) primary care; (2) gynecologic care; and (3) preventive health care among women.
Materials and Methods:
We recruited 4,000 participants from a probability-based online panel. We conducted four multinomial logistic regression models, one for each of the study outcomes: (1) primary care access; (2) gynecologic care access; (3) patient-initiated disruptions to preventive visits; and (4) provider-initiated disruptions to preventive visits.
Results:
The sample included 1,285 women. One in four women (28.5%) reported that the pandemic affected their primary care access. Sexual minority women (SMW) (odds ratios [OR]: 1.67; 95% confidence intervals [CI]: 1.19–2.33) had higher odds of reporting pandemic-related effects on primary care access compared to women identifying as heterosexual. Cancer survivors (OR: 2.07; 95% CI: 1.25–3.42) had higher odds of reporting pandemic-related effects on primary care access compared to women without a cancer history. About 16% of women reported that the pandemic affected their gynecologic care access. Women with a cancer history (OR: 2.34; 95% CI: 1.35–4.08) had higher odds of reporting pandemic-related effects on gynecologic care compared to women without a cancer history. SMW were more likely to report patient- and provider-initiated delays in preventive health care. Other factors that affected health care access included income, insurance status, and having a usual source of care.
Conclusions:
The COVID-19 pandemic disrupted women's health care access and disproportionately affected access among SMW and women with a cancer history, suggesting that targeted interventions may be needed to ensure adequate health care access during the COVID-19 pandemic.
Get full access to this article
View all access options for this article.
References
1.
OnarheimKH, IversenJH, BloomDE. Economic benefits of investing in women's health: A systematic review. PLoS One, 2016; 11(3):e0150120; doi: 10.1371/journal.pone.0150120
2.
HermanD, AfulaniP, Coleman-JensenA, et al.Food insecurity and cost-related medication underuse among nonelderly adults in a nationally representative sample. Am J Public Health, 2015; 105(10):e48–e59; doi: 10.2105/AJPH.2015.302712
3.
RanjiU, RosenzweigC, SalganicoffA.Women's Coverage, Access, and Affordability: Key Findings from the 2017 Kaiser Women's Health Survey. Washington, DC: Kaiser Family Foundation; 2018.
4.
CollinsC, LandivarLC, RuppannerL, et al.COVID-19 and the Gender Gap in Work Hours. Gend Work Organ, 2021; 28(Suppl 1):101–112; doi: 10.1111/gwao.12506
5.
ZamarroG, PradosMJ. Gender differences in couples' division of childcare, work and mental health during COVID-19. Rev Econ Househ, 2021; 19(1):11–40; doi: 10.1007/s11150-020-09534-7
6.
FryR.Some gender disparities widened in the U.S. workforce during the pandemic. Washington, DC: Pew Research Center;. 2022.
7.
YavorskyJE, QianY, SargentAC. The gendered pandemic: The implications of COVID-19 for work and family. Sociol Compass, 2021; 15(6):e12881; doi: 10.1111/soc4.12881
8.
WhaleyCM, PeraMF, CantorJ, et al.Changes in health services use among commercially insured US populations during the COVID-19 pandemic. JAMA Netw Open, 2020; 3(11):e2024984; doi: 10.1001/jamanetworkopen.2020.24984
9.
ChenRC, HaynesK, DuS, et al.Association of cancer screening deficit in the United States with the COVID-19 pandemic. JAMA Oncol, 2021; 7(6):878–884; doi: 10.1001/jamaoncol.2021.0884
10.
DeGroffA, MillerJ, SharmaK, et al.COVID-19 impact on screening test volume through the National Breast and Cervical Cancer early detection program, January-June 2020, in the United States. Prev Med, 2021; 151:106559; doi: 10.1016/j.ypmed.2021.106559
11.
MillerMJ, XuL, QinJ, et al.Impact of COVID-19 on cervical cancer screening rates among women aged 21–65 years in a large integrated health care system—Southern California, January 1-September 30, 2019, and January 1-September 30, 2020. MMWR Morb Mortal Wkly Rep, 2021; 70(4):109–113; doi: 10.15585/mmwr.mm7004a1
12.
MarcondesFO, ChengD, WarnerET, et al.The trajectory of racial/ethnic disparities in the use of cancer screening before and during the COVID-19 pandemic: A large U.S. academic center analysis. Prev Med, 2021; 151:106640; doi: 10.1016/j.ypmed.2021.106640
13.
StephensonE, O'NeillB, GronsbellJ, et al.Changes in family medicine visits across sociodemographic groups after the onset of the COVID-19 pandemic in Ontario: A retrospective cohort study. CMAJ Open, 2021; 9(2):E651–E658; doi: 10.9778/cmajo.20210005
14.
LindbergLD, VandeVusseA, MuellerJ, et al.Early Impacts of the COVID-19 Pandemic: Findings from the 2020 Guttmacher Survey of Reproductive Health Experiences. New York, NY: Guttmacher Institute; 2020.
15.
ChurchK, GassnerJ, ElliottM. Reproductive health under COVID-19—Challenges of responding in a global crisis. Sex Reprod Health Matters, 2020; 28(1):1–3; doi: 10.1080/26410397.2020.1773163
16.
ChinnJJ, MartinIK, RedmondN. Health equity among Black Women in the United States. J Womens Health (Larchmt), 2021; 30(2):212–219; doi: 10.1089/jwh.2020.8868
17.
CoughlinSS, LeadbetterS, RichardsT, et al.Contextual analysis of breast and cervical cancer screening and factors associated with health care access among United States women, 2002. Soc Sci Med, 2008; 66(2):260–275; doi: 10.1016/j.socscimed.2007.09.009
18.
BrenickA, RomanoK, KeglerC, et al.Understanding the influence of stigma and medical mistrust on engagement in routine healthcare among Black Women who have sex with women. LGBT Health, 2017; 4(1):4–10; doi: 10.1089/lgbt.2016.0083
19.
HiestandKR, HorneSG, LevittHM. Effects of gender identity on experiences of healthcare for sexual minority women. J LGBT Health Res, 2007; 3(4):15–27; doi: 10.1080/15574090802263405
20.
TimminsCL.The impact of language barriers on the health care of Latinos in the United States: A review of the literature and guidelines for practice. J Midwifery Womens Health, 2002; 47(2):80–96; doi: 10.1016/s1526-9523(02)00218-0
21.
BazziAR, WhormsDS, KingDS, et al.Adherence to mammography screening guidelines among transgender persons and sexual minority women. Am J Public Health, 2015; 105(11):2356–2358; doi: 10.2105/AJPH.2015.302851
22.
PorschLM, ZhangH, DayanandaI, et al.Comparing receipt of cervical cancer screening and completion of human papillomavirus vaccination using a new construct of sexual orientation: A serial cross-sectional study. LGBT Health, 2019; 6(4):184–191; doi: 10.1089/lgbt.2018.0196
23.
BuchmuellerT, CarpenterCS. Disparities in health insurance coverage, access, and outcomes for individuals in same-sex versus different-sex relationships, 2000–2007. Am J Public Health, 2010; 100(3):489–495; doi: 10.2105/AJPH.2009.160804
24.
GonzalesG, BlewettLA. National and state-specific health insurance disparities for adults in same-sex relationships. Am J Public Health, 2014; 104(2):e95–e104; doi: 10.2105/AJPH.2013.301577
25.
GonzalesG, OrtizK. Health insurance disparities among racial/ethnic minorities in same-sex relationships: An intersectional approach. Am J Public Health, 2015; 105(6):1106–1113; doi: 10.2105/AJPH.2014.302459
26.
TabaacAR, SolazzoAL, GordonAR, et al.Sexual orientation-related disparities in healthcare access in three cohorts of U.S. adults. Prev Med, 2020; 132:105999; doi: 10.1016/j.ypmed.2020.105999
27.
MartinoRJ, KrauseKD, GriffinM, et al.Employment loss as a result of COVID-19: A nationwide survey at the onset of COVID-19 in US LGBTQ+ populations. Sex Res Social Policy, 2021; 1–12. [Epub ahead of print]; doi: 10.1007/s13178-021-00665-9
28.
DawsonL, KirzingerA, KatesJ.The Impact of the COVID-19 Pandemic on LGBT Peo ple. Kaiser Family Foundation; 2021. Available from: https://www.kff.org/coronavirus-covid-19/poll-finding/the-impact-of-the-covid-19-pandemic-on-lgbt-people/ [Last accessed: June 17, 2022].
29.
BureauUC.Employment Situation Summary. Washington, DC; 2022. Available from: https://www.bls.gov/news.release/empsit.nr0.htm [Last accessed: June 17, 2022].
30.
KimY, DykemaJ, StevensonJ, et al.Straightlining: Overview of measurement, comparison of indicators, and effects in mail–web mixed-mode surveys. Soc Sci Comput Rev, 2019; 37(2):214–233; doi: 10.1177/0894439317752406
31.
ArevaloM, BrownsteinNC, WhitingJ, et al.Strategies and lessons learned during cleaning of data from research panel participants: Cross-sectional web-based health behavior survey study. JMIR Form Res, 2022; 6(6):e35797; doi: 10.2196/35797
32.
CurrySJ, KristAH, OwensDK, et al.Screening for cervical cancer: US Preventive Services Task Force Recommendation Statement. JAMA, 2018; 320(7):674–686; doi: 10.1001/jama.2018.10897
33.
GerendMA, ShepherdMA, ShepherdJE. The multidimensional nature of perceived barriers: Global versus practical barriers to HPV vaccination. Health Psychol, 2013; 32(4):361–369; doi: 10.1037/a0026248
34.
HeinzeG, WallischC, DunklerD. Variable selection—A review and recommendations for the practicing statistician. Biom J, 2018; 60(3):431–449; doi: 10.1002/bimj.201700067
35.
WesterRA, RubelJ, MayerA.Covariate selection for estimating individual treatment effects in psychotherapy research: A simulation study and empirical example. Clin Psychol Sci, 2022. [Epub ahead of print]; doi: 10.1177/21677026211071043
36.
von ElmE, AltmanDG, EggerM, et al.The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. Int J Surg, 2014; 12(12):1495–1499; doi: 10.1016/j.ijsu.2014.07.013
37.
AdayLA, AndersenR. A framework for the study of access to medical care. Health Serv Res, 1974; 9(3):208–220.
38.
PhillipsKA, MorrisonKR, AndersenR, et al.Understanding the context of healthcare utilization: Assessing environmental and provider-related variables in the behavioral model of utilization. Health Serv Res, 1998; 33(3 Pt 1):571–596.
39.
AustinSB, PazarisMJ, NicholsLP, et al.An examination of sexual orientation group patterns in mammographic and colorectal screening in a cohort of U.S. women. Cancer Causes Control, 2013; 24(3):539–547; doi: 10.1007/s10552-012-9991-0
40.
KerkerBD, MostashariF, ThorpeL. Health care access and utilization among women who have sex with women: Sexual behavior and identity. J Urban Health, 2006; 83(5):970–979; doi: 10.1007/s11524-006-9096-8
41.
BustamanteG, ReiterPL, McReeAL. Cervical cancer screening among sexual minority women: Findings from a national survey. Cancer Causes Control, 2021; 32(8):911–917; doi: 10.1007/s10552-021-01442-0
42.
TracyJK, SchlutermanNH, GreenbergDR. Understanding cervical cancer screening among lesbians: A national survey. BMC Public Health, 2013; 13:442; doi: 10.1186/1471-2458-13-442
43.
AgénorM, KriegerN, AustinSB, et al.Sexual orientation disparities in Papanicolaou test use among US women: The role of sexual and reproductive health services. Am J Public Health, 2014; 104(2):e68–e73; doi: 10.2105/AJPH.2013.301548
44.
ReiterPL, McReeAL, KatzML, et al.Human papillomavirus vaccination among young adult gay and bisexual men in the United States. Am J Public Health, 2015; 105(1):96–102; doi: 10.2105/AJPH.2014.302095
45.
ApaydinKZ, FontenotHB, ShtaselD, et al.Facilitators of and barriers to HPV vaccination among sexual and gender minority patients at a Boston community health center. Vaccine, 2018; 36(26):3868–3875; doi: 10.1016/j.vaccine.2018.02.043
46.
NadarzynskiT, SmithH, RichardsonD, et al.Human papillomavirus and vaccine-related perceptions among men who have sex with men: A systematic review. Sex Transm Infect, 2014; 90(7):515–523; doi: 10.1136/sextrans-2013-051357
47.
FontenotHB, FantasiaHC, VettersR, et al.Increasing HPV vaccination and eliminating barriers: Recommendations from young men who have sex with men. Vaccine, 2016; 34(50):6209–6216; doi: 10.1016/j.vaccine.2016.10.075
48.
GerendMA, MadkinsK, CrosbyS, et al.A qualitative analysis of young sexual minority men's perspectives on human papillomavirus vaccination. LGBT Health, 2019; 6(7):350–356; doi: 10.1089/lgbt.2019.0086
49.
PrzedworskiJM, McAlpineDD, Karaca-MandicP, et al.Health and health risks among sexual minority women: An examination of 3 subgroups. Am J Public Health, 2014; 104(6):1045–1047; doi: 10.2105/AJPH.2013.301733
50.
CharltonBM, GordonAR, ReisnerSL, et al.Sexual orientation-related disparities in employment, health insurance, healthcare access and health-related quality of life: A cohort study of US male and female adolescents and young adults. BMJ Open, 2018; 8(6):e020418; doi: 10.1136/bmjopen-2017-020418
51.
GonzalesG, EhrenfeldJM. the association between state policy environments and self-rated health disparities for sexual minorities in the United States. Int J Environ Res Public Health, 2018; 15(6):1136; doi: 10.3390/ijerph15061136
52.
KleinDA, MalcolmNM, Berry-BibeeEN, et al.Quality primary care and family planning services for LGBT clients: A comprehensive review of clinical guidelines. LGBT Health, 2018; 5(3):153–170; doi: 10.1089/lgbt.2017.0213
53.
FuzzellLN, PerkinsRB, ChristySM, et al.Cervical cancer screening in the United States: Challenges and potential solutions for underscreened groups. Prev Med, 2021; 144:106400; doi: 10.1016/j.ypmed.2020.106400
54.
ACS. COVID-19 pandemic impact on cancer patients and survivors. 2020. Available from: https://www.fightcancer.org/sites/default/files/National%20Documents/Survivor%20Views.COVID19%20Polling%20Memo.Final_.pdf [Last accessed: March 29, 2022].
55.
Luctkar-FludeM, AikenA, McCollMA, et al.Are primary care providers implementing evidence-based care for breast cancer survivors?. Can Fam Physician, 2015; 61(11):978–984.
56.
SuhE, DaughertyCK, WroblewskiK, et al.General internists' preferences and knowledge about the care of adult survivors of childhood cancer: A cross-sectional survey. Ann Intern Med, 2014; 160(1):11–17; doi: 10.7326/M13-1941
57.
KenisonTC, SilvermanP, SustinM, et al.Differences between nurse practitioner and physician care providers on rates of secondary cancer screening and discussion of lifestyle changes among breast cancer survivors. J Cancer Surviv, 2015; 9(2):223–229; doi: 10.1007/s11764-014-0405-z
58.
HewittME, BamundoA, DayR, et al.Perspectives on post-treatment cancer care: Qualitative research with survivors, nurses, and physicians. J Clin Oncol, 2007; 25(16):2270–2273; doi: 10.1200/JCO.2006.10.0826
59.
ChubakJ, TuzzioL, HsuC, et al.Providing care for cancer survivors in integrated health care delivery systems: Practices, challenges, and research opportunities. J Oncol Pract, 2012; 8(3):184–189; doi: 10.1200/JOP.2011.000312
McCabeMS, BhatiaS, OeffingerKC, et al.American Society of Clinical Oncology statement: Achieving high-quality cancer survivorship care. J Clin Oncol, 2013; 31(5):631–640; doi: 10.1200/JCO.2012.46.6854
62.
HowellD, HackTF, OliverTK, et al.Models of care for post-treatment follow-up of adult cancer survivors: A systematic review and quality appraisal of the evidence. J Cancer Surviv, 2012; 6(4):359–371; doi: 10.1007/s11764-012-0232-z
63.
HalpernMT, ViswanathanM, EvansTS, et al.Models of cancer survivorship care: Overview and summary of current evidence. J Oncol Pract, 2015; 11(1):e19–e27; doi: 10.1200/JOP.2014.001403
64.
NekhlyudovL, O'MalleyDM, HudsonSV. Integrating primary care providers in the care of cancer survivors: Gaps in evidence and future opportunities. Lancet Oncol, 2017; 18(1):e30–e38; doi: 10.1016/S1470-2045(16)30570-8
65.
SchlumbrechtM, SunC, HuangM, et al.Gynecologic cancer survivor preferences for long-term surveillance. BMC Cancer, 2018; 18(1):375; doi: 10.1186/s12885-018-4313-x
66.
KewFM, GalaalK, MandervilleH. Patients' views of follow-up after treatment for gynaecological cancer. J Obstet Gynaecol, 2009; 29(2):135–142; doi: 10.1080/01443610802646801
67.
DahlL, WittrupI, VæggemoseU, et al.Life after gynecologic cancer—A review of patients quality of life, needs, and preferences in regard to follow-up. Int J Gynecol Cancer, 2013; 23(2):227–234; doi: 10.1097/IGC.0b013e31827f37b0
68.
GreimelE, LahousenM, DorferM, et al.Patients' view of routine follow-up after gynecological cancer treatment. Eur J Obstet Gynecol Reprod Biol, 2011; 159(1):180–183; doi: 10.1016/j.ejogrb.2011.06.027
69.
FaubionSS, MacLaughlinKL, LongME, et al.Surveillance and care of the gynecologic cancer survivor. J Womens Health (Larchmt), 2015; 24(11):899–906; doi: 10.1089/jwh.2014.5127
70.
CampbellG, ThomasTH, HandL, et al.Caring for survivors of gynecologic cancer: Assessment and management of long-term and late effects. Semin Oncol Nurs, 2019; 35(2):192–201; doi: 10.1016/j.soncn.2019.02.006
71.
CroswellJM, CorleyDA, LafataJE, et al.Cancer screening in the U.S. through the COVID-19 pandemic, recovery, and beyond. Prev Med, 2021; 151:106595; doi: 10.1016/j.ypmed.2021.106595
72.
HannaK, ArredondoBL, ChavezMN, et al.Cancer screening among rural and urban clinics during COVID-19: A multistate qualitative study. JCO Oncol Pract, 2022; 18(6):e1045–e1055; doi: 10.1200/OP.21.00658
73.
KukharevaPV, CaverlyTJ, LiH, et al.Inaccuracies in electronic health records smoking data and a potential approach to address resulting underestimation in determining lung cancer screening eligibility. J Am Med Inform Assoc, 2022; 29(5):779–788; doi: 10.1093/jamia/ocac020
74.
StaroselskyM, VolkLA, TsurikovaR, et al.Improving electronic health record (EHR) accuracy and increasing compliance with health maintenance clinical guidelines through patient access and input. Int J Med Inform, 2006; 75(10–11):693–700; doi: 10.1016/j.ijmedinf.2005.10.004
75.
NguyenOT, HongYR, Alishahi TabrizA, et al.Prevalence and factors associated with patient-requested corrections to the medical record through use of a patient portal: Findings from a national survey. Appl Clin Inform, 2022; 13(1):242–251; doi: 10.1055/s-0042-1743236
76.
BureauUSC.2020. Census Illuminates Racial and Ethnic Composition of the Country. Bureau USC: Washington, DC; 2020.
77.
MehrotraA, ChernewME, LinetskyD, et al.The Impact of the COVID-19 Pandemic on Outpatient Visits: A Rebound Emerges. Washington, DC.; 2020. Available from: https://www.commonwealthfund.org/publications/2020/apr/impact-covid-19-outpatient-visits [Last accessed: September 1, 2022].
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
