Racial and ethnic disparities in access to non-COVID-19 healthcare during the pandemic in the United States

Abstract

Access to healthcare-defined as the ability to obtain timely and necessary medical services - is critical during public health emergencies. The Coronavirus Disease 2019 (COVID-19) pandemic (2020–2021) substantially disrupted routine healthcare delivery in the United States, particularly affecting racial and ethnic minority groups who already face barriers to care. While previous studies have examined disparities in COVID-related outcomes, fewer have assessed racial differences in access to care for non-COVID-19 conditions over an extended pandemic period. This study investigated whether race and ethnicity were associated with limited or delayed access to non-COVID-19 healthcare services during the COVID-19 pandemic in the U.S. We used cross-sectional, nationally representative data from the National Health Interview Survey (NHIS) from July 2020 to December 2021. The analytic sample included 40,955 U.S. adults aged 25 years and older. Survey-weighted logistic regression models accounting for the NHIS complex sampling design (strata and primary sampling units) were used to estimate associations between race/ethnicity and 2 binary outcomes: inability to obtain needed non-COVID-19 medical care and delays in receiving such care, adjusting for demographic, socioeconomic, and health-related covariates. Complete-case analysis was used due to minimal missingness. Sensitivity analyses using alternative weight rescaling produced substantively similar results. All results are based on the weighted sample; however, unweighted results are provided in the appendix. Among respondents, 13.8% reported being unable to access needed care, and 21.5% reported delaying care during the pandemic. After adjustment, American Indian/Alaskan Native and multiracial individuals were significantly more likely to experience barriers to care, with lower odds of receiving needed care (odds ratio [OR] = 0.64; 95% confidence interval [CI]: 0.534–0.782) and higher odds of delay (OR = 1.5; 95% CI: 1.247–1.813). Non-Hispanic Asian respondents were least likely to delay care (OR = 0.67; 95% CI: 0.585–0.774). Racial and ethnic disparities in access to non-COVID-19 healthcare were observed throughout the pandemic period. The observed disparities are consistent with prior literature on inequities in healthcare access during public health emergencies and may help inform future research and policy discussions regarding healthcare access during future emergencies.