Gender disparities in access to care for time-sensitive conditions during COVID-19 pandemic in Chile
Authors: Pacheco Jorge , Crispi Francisca , Alfaro Tania , Martínez María Soledad , Cuadrado Cristóbal 
Published: September 2020

AbstractIntroductionDuring the COVID-19 pandemic reduction on the utilisation of healthcare services are reported in different contexts. Nevertheless, studies have not explored specifically gender disparities on access to healthcare.AimTo evaluate disparities in access to care in Chile during the COVID-19 pandemic from a gender-based perspective.MethodsWe conducted a quasi-experimental design using a difference-in-difference approach. We compared the number of weekly confirmed cases of a set of oncologic and cardiovascular time-sensitive conditions at a national level. We defined weeks 12 to 26 as an intervention period and the actual year as a treatment group. We selected this period because preventive interventions, such as school closures or teleworking, were implemented at this point. To test heterogeneity by sex, we included an interaction term between difference-in-difference estimator and sex.ResultsA sizable reduction in access to care for patients with time-sensitivity conditions was observed for oncologic (IRR 0·56; 95% CI 0·50-0·63) and cardiovascular diseases (IRR 0·64; 95% CI 0·62-0·66). Greater reduction occurred in women compared to men across diseases groups, particularly marked on myocardial infarction (0·89; 95% CI 0·85-0·93), stroke (IRR 0·88 IC95% 0·82-0·93), and colorectal cancer (IRR 0·79; 95% CI 0·69-0·91). Compared to men, a greater absolute reduction in women for oncologic diseases (782; 95% CI 704-859) than cardiovascular diseases (172; 95% CI 170-174) occurred over 14 weeks.ConclusionWe confirmed a large drop in new diagnosis for time-sensitive conditions during the COVID-19 pandemic in Chile. This reduction was greater for women. Our findings should alert policy-makers about the urgent need to integrate a gender perspective into the pandemic response and its aftermath.Research in contextWe searched PubMed, Google Scholar and medRxiv using the search terms "Health Services” AND “Access* AND “gender” AND (“pandemics” OR “COVID” OR “SARS-CoV2”) on the title and abstract for research published in 2020, with no language restrictions. Reports of a decrease in healthcare access were common during the pandemic for cardiovascular and oncologic diseases in various countries. Only three studies explored gender differences in access to healthcare for time-sensitive conditions. These studies did not find a differential impact between genders. None of these studies were conducted in settings with higher levels of gender inequalities such as Latin America.Added value of this studyTo our knowledge, this is the first study in Latin America that explores gender differences in access to care during the COVID-19 pandemic. We confirmed a large decrease in medical diagnosis in women compared to men for a broad group of time-sensitive cardiovascular and oncologic diseases. We used a comprehensive and reliable national database to test our hypothesis. The effect was evident in conditions with different etiological mechanisms, so it is highly implausible to explain our finding through biological causes. Gender norms and hierarchies better explain this wide effect. An increase in care workload due to school closure and aggravation of gender bias due to scarcity could explain this reduced healthcare utilisation in women during the pandemic.Implications of all the available evidenceOur findings should alert policy-makers about the urgent need to integrate a gender perspective on the current outbreak response. If school closure has a role in the observed differential effect, increasing healthcare services availability will not shorten disparities between sexes. Services provision should enhance access during COVID-19 pandemic, especially for women who are raising children or have other caregiver responsibilities.