Delay or Avoidance of Medical Care Because of COVID-19–Related Concerns — United States, June 2020
Authors: Mark É. Czeisler, Kristy Marynak, Kristie E.N. Clarke, Zainab Salah, Iju Shakya, JoAnn M. Thierry, Nida Ali, Hannah McMillan, Joshua F. Wiley, Matthew D. Weaver, Charles A. Czeisler, Shantha M.W. Rajaratnam, Mark E. Howard
Journal: MMWR Morbidity and Mortality Weekly Report (2020)

CharacteristicNo. (%) † Type of medical care delayed or avoided* Urgent or emergency Routine Any % † P-value § % † P-value § % † P-value § Knew someone who died from COVID-19 Yes 364 (7.3) 10.1 0.348 41.4 <0.001 46.3 0.048 No 4,611 (92.7) 12.2 30.7 40.5 Believed to be in group at high risk for severe COVID-19 Yes 981 (19.7) 10.0 0.050 42.5 <0.001 49.4 <0.001No 3,994 (80.3) 12.5 28.8 38.8 Abbreviations: CI = confidence interval; COVID-19 = coronavirus disease 2019; USD = U.S. dollars.* The types of medical care avoidance are not mutually exclusive; respondents had the option to indicate that they had delayed or avoided more than one type of medical care (i.e., routine medical care and urgent/emergency medical care).† Statistical raking and weight trimming were employed to improve the cross-sectional June cohort representativeness of the U.S. population by gender, age, and race/ethnicity according to the 2010 U.S. Census.§ The Rao-Scott adjusted Pearson chi-squared test was used to test for differences in observed and expected frequencies among groups by characteristic for avoidance of each type of medical care (e.g., whether avoidance of routine medical care differs significantly by gender).Statistical significance was evaluated at a threshold of α = 0.05.¶ "Other" race includes American Indian or Alaska Native, Native Hawaiian or Pacific Islander, or Other.** Persons who had a disability were defined as such based on a qualifying response to either one of two questions: "Are you limited in any way in any activities because of physical, mental, or emotional condition?"and "Do you have any health conditions that require you to use special equipment, such as a cane, wheelchair, special bed, or special telephone?"https://www.cdc.gov/brfss/questionnaires/pdf-ques/2015-brfss-questionnaire-12-29-14.pdf.† † Selected underlying medical conditions known to increase the risk for severe COVID-19 included in this analysis were obesity, diabetes, high blood pressure, cardiovascular disease, and any type of cancer.Obesity is defined as body mass index ≥30 kg/m 2 and was calculated from self-reported height and weight (https:// www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html).The remaining conditions were assessed using the question "Have you ever been diagnosed with any of the following conditions?" with response options of 1) "Never"; 2) "Yes, I have in the past, but don't have it now"; 3) "Yes I have, but I do not regularly take medications or receive treatment"; and 4) "Yes I have, and I am regularly taking medications or receiving treatment." Respondents who answered that they have been diagnosed and chose either response 3 or 4 were considered as having the specified medical condition.§ § Essential worker status was self-reported.¶ ¶ Unpaid caregiver status was self-reported.Unpaid caregivers for adults were defined as having provided unpaid care to a relative or friend aged ≥18 years at any time in the last 3 months.Examples provided to survey respondents included helping with personal needs, household chores, health care tasks, managing a person's finances, taking them to a doctor's appointment, arranging for outside services, and visiting regularly to see how they are doing.*** Region classification was determined by using the U.S. Census Bureau's Census Regions and Divisions.https://www2.