Healthcare avoidance during the early stages of the COVID-19 pandemic and all-cause mortality: a longitudinal community-based study.

Abstract

During the COVID-19 pandemic, global trends of reduced healthcare-seeking behaviour were observed. This raises concerns about the consequences of healthcare avoidance for population health. To determine the association between healthcare avoidance during the early stages of the COVID-19 pandemic and all-cause mortality. This was a 32-month follow-up within the population-based Rotterdam Study, after sending a COVID-19 questionnaire at the onset of the pandemic in April 2020 to all communty dwelling participants (<i>n</i> = 6241/8732, response rate 71.5%). Cox proportional hazards models assessed the risk of all-cause mortality among respondents who avoided health care because of the COVID-19 pandemic. Mortality status was collected through municipality registries and medical records. Of 5656 respondents, one-fifth avoided health care because of the COVID-19 pandemic (<i>n</i> = 1143). Compared with non-avoiders, those who avoided health care more often reported symptoms of depression (<i>n</i> = 357, 31.2% versus <i>n</i> = 554, 12.3%) and anxiety (<i>n</i> = 340, 29.7% versus <i>n</i> = 549, 12.2%), and more often rated their health as poor to fair (<i>n</i> = 336, 29.4% versus <i>n</i> = 457, 10.1%) . Those who avoided health care had an increased adjusted risk of all-cause mortality (hazard ratio [HR] 1.30, 95% confidence interval [CI] = 1.01 to 1.67), which remained nearly identical after adjustment for history of any non-communicable disease (HR 1.20, 95% CI = 0.93 to 1.54). However, this association attenuated after additional adjustment for mental and physical self-perceived health factors (HR 0.93, 95% CI = 0.71 to 1.20). This study found an increased risk of all-cause mortality among individuals who avoided health care during COVID-19. These individuals were characterised by poor mental and physical self-perceived health. Therefore, interventions should be targeted to these vulnerable individuals to safeguard their access to primary and specialist care to limit health disparities, inside and beyond healthcare crises.