Impact of COVID-19 on healthcare access for Australian adolescents and young adults

  1. Md Irteja Islam
  2. Joseph Freeman
  3. Verity Chadwick
  4. Alexandra Martiniuk

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Abstract

Background

Access to healthcare for young people is essential to build the foundation for a healthy life. We investigated the factors associated with healthcare access by Australian young adults during and before the COVID-19 pandemic.

Methods

We included 1110 youths using two recent data collection waves from the Longitudinal Study of Australian Children (LSAC). Data were collected during COVID-19 in 2020 for Wave 9C1 and before COVID-19 in 2018 for Wave 8. The primary outcome for this study was healthcare access. Both bivariate and multivariate logistic regression models were employed to identify the factors associated with reluctance to access healthcare services during COVID-19 and pre-COVID-19 times.

Results

Among respondents, 39.6% avoided seeking health services during the first year of the COVID-19 pandemic when they needed them, which was similar to pre-COVID-19 times (41.4%). The factors most strongly impacting upon reluctance and/or barriers to healthcare access during COVID-19 were any illness or disability, and high psychological distress. In comparison, prior to the pandemic the factors which were significantly impeding healthcare access were country of birth, state of residence, presence of any pre-existing condition and psychological distress. The most common reason reported (55.9%) for avoided seeking care was that they thought the problem would go away.

Conclusions

A significant proportion of youths did not seek care when they felt they needed to seek care, both during and before the COVID-19 pandemic.

What is known about the subject?

  • Some adolescents and young adults do not access healthcare when they need it.

  • Healthcare access and barriers to access is best understood through a multi-system lens including policy, organisational, and individual-level factors. For instance, policy barriers (such as cost), organisational barriers (such as transportation, or difficulty accessing a timely appointment) and individual barriers (such as experiences, knowledge or beliefs).

  • Barriers to care may differ for sub-groups e.g. rural

  • During the COVID-19 pandemic, public health restrictions including the stricter “lockdowns” have reduced healthcare access. The burden of cases upon the healthcare system has further reduced healthcare access.

What this study adds?

  • A significant proportion of youth did not seek healthcare when they felt they needed to seek care, both before (41.4%) and during the first year of the COVID-19 pandemic (39.6%)

  • Youth with a disability or chronic condition, asthma and/or psychological distress were more likely to avoid accessing healthcare during COVID-19 times.

  • The most common reason for not seeking healthcare when it was felt to be needed was because the youth thought the problem would go away (pre-COVID-19 35.7% of the sample versus during the first year of COVID-19 55.9%)

  • During the coronavirus restriction period (“lockdown”) the most common reason for not seeking healthcare when it was felt to be needed was because the youth did not want to visit a doctor during lockdown (21.8%) with the next most common reason being because telehealth was the only appointment option available at the time (8.4%)

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  1. ScreenIT

    SciScore for 10.1101/2021.12.01.21267121: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsField Sample Permit: The details of the LSAC study design, sampling technique and data collection procedures are described elsewhere.25 For this current study, we analysed 1110 of the older cohort (now aged 20-21 years).
    Sex as a biological variableExposure variables: We selected independent variables based on previous studies that identified determinants of health service utilization.26, 27 Demographic characteristics included sex (male and female), country of birth (overseas and Australia), states (New South Wales, Victoria, Queensland and Others), remoteness (major cities and regional/remote), schooling (technical/others and university/tertiary), employment (unemployed and employed), living with parents (no and yes), family cohesion (poor and strong), socioeconomic status using Index of Relative Socioeconomic Advantage and Disadvantage (IRSAD) quintiles (Q1-most disadvantaged to Q5-most advantaged).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: Thank you for sharing your data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    This study was not without limitations. The sample was not entirely representative of Australian youths; there was an under-representation of Australians born overseas (5% vs. population 30%) and living in rural or remote areas.36 Furthermore, most respondents lived at home and reported high family cohesion. Known risk factors for poorer health outcomes include youths living out of home and in insecure housing.37 Further research could focus on barriers to healthcare access for youths who live out of home and how the COVID-19 pandemic may have impacted this group of young people. Another limitation is that this paper describes perceived barriers to healthcare use, not actual healthcare use. Those who perceived more barriers to care may still have accessed healthcare on multiple other occasions during the 12-month study period for each wave of data collection, and possibly more than those who did not identify any barriers to healthcare. In conclusion, a significant proportion of young adults did not seek care when they felt they needed to seek healthcare during and before the COVID-19 pandemic. The COVID-19 pandemic both modified existing barriers to healthcare access for youth and created new barriers.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

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  2. Version published to 10.1101/2021.12.01.21267121v1 on medRxiv