Gender disparities in access to care for time-sensitive conditions during COVID-19 pandemic in Chile

  1. Jorge Pacheco
  2. Francisca Crispi
  3. Tania Alfaro
  4. María Soledad Martínez
  5. Cristóbal Cuadrado

Reviewed by

Read the full article

Listed in

Log in to save this article

Abstract

Background

During the COVID-19 pandemic, reductions in healthcare utilization are reported in different contexts. Nevertheless, studies have not explored specifically gender disparities in access to healthcare in the context of COVID-19.

Methods

To evaluate gender disparities in access to medical in Chile we conducted an interrupted time series analysis using segmented regression. The outcome variable was the number of weekly confirmed cases of a set of oncologic and cardiovascular time-sensitive conditions at a national level. The series contained data from weeks 1 to 39 for 2017 to 2020. The intervention period started at week 12. We selected this period because preventive interventions, such as school closures or teleworking, were implemented at this point. We estimated the level effect using a dummy variable indicating the intervention period and slope effect using a continuous variable from weeks 12 to 39. To test heterogeneity by gender and age group, we conducted a stratified analysis.

Results

We observed a sizable reduction in access to care with a slowly recovery for oncologic (level effect 0.323; 95% CI 0.291–0.359; slope effect 1.022; 95% CI 1.016–1.028) and cardiovascular diseases (level effect 0.586; 95% CI 0.564–0.609; slope effect 1.009; 95% CI 1.007–1.011). Greater reduction occurred in women compared to men, particularly marked on myocardial infarction (level effect 0.595; 95% CI 0.566–0.627 versus 0.532; 95% CI 0.502–0.564) and colorectal cancer (level effect 0.295; 95% CI 0.248–0.35 versus 0.19; 95% CI 0.159–0.228). Compared to men, a greater absolute reduction was observed in women for oncologic diseases, excluding sex-specific cancer, (1352; 95% CI 743–1961) and cardiovascular diseases (1268; 95% CI 946–1590).

Conclusion

We confirmed a large drop in new diagnoses 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.

Article activity feed

  1. Version published to 10.1186/s12889-021-11838-x
  2. ScreenIT

    SciScore for 10.1101/2020.09.11.20192880: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementIRB: Ethics: Since this study used secondary data from publicly available sources collected by the Ministry of Health, which are registered anonymously, we did not require institutional review board approval.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    We used STATA 16.0 for analyses and R 4.0.2 for graphs.
    STATA
    suggested: (Stata, RRID:SCR_012763)

    Results from OddPub: Thank you for sharing your code and data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    This study has several limitations. First, we use administrative data, which might be subject to underreporting during the pandemic. Nevertheless, confirmed case reports have been mandatory for healthcare providers since 2004. Moreover, they are used for health claim payments in the Chilean health system, therefore making it less likely that reduced reporting could explain the observed effect. Second, due to the data codification, this study only considers two categories for sex and gender (female and male). This dichotomy excludes a spectrum of gender identities and the intersex population.18 Future studies must explore differential effects on health care accessibility during pandemics for a broader gender classification. Third, we cannot rule out residual confounding in the context of observational data. Nevertheless, due to the characteristic of the exposure of interest (the pandemic) is unlikely that better data could be obtained using alternative sources or study designs. We controlled confirmed cases by population and age in our models and included seasonal adjustments by week and year to control for unobserved time-specific confounding factors. The use of previous year trends as a control for the same observational units allows adjustment for confounding, but since no parallel control group was available adjustment for other time-variant effects concomitants to the pandemic was not feasible. As strengths, this is the first study from Latin America that explores access ...

    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.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.09.11.20192880v1 on medRxiv