Key Points Question How did health services use among commercially insured populations change during the initial phase of the coronavirus disease 2019 (COVID-19) pandemic in the United States? Findings This cross-sectional study with a claims-based analysis of 6.8 million commercially insured individuals found that during the initial phase of the COVID-19 epidemic in March and April of 2020, patients significantly reduced use of preventive and elective care and increased use of telemedicine but not enough to offset reductions in in-person care. Racial/ethnic and income disparities were seen in changes in use of in-person care and telemedicine. Meaning In this study, the initial 2 months of the COVID-19 pandemic were associated with large reductions in use of health services; future policy initiatives should ensure that these reductions do not adversely affect patient health. This cross-sectional study analyzes health insurance claims among commercially-insured individuals to asess changes in the use of health services in the Unted States during the initial phase of the COVID-19 pandemic. Importance The coronavirus disease 2019 (COVID-19) pandemic has placed unprecedented strain on patients and health care professionals and institutions, but the association of the pandemic with use of preventive, elective, and nonelective care, as well as potential disparities in use of health care, remain unknown. Objective To examine changes in health care use during the first 2 months of the COVID-19 pandemic in March and April of 2020 relative to March and April of 2019 and 2018, and to examine whether changes in use differ by patient’s zip code–level race/ethnicity or income. Design, Setting, and Participants This cross-sectional study analyzed health insurance claims for patients from all 50 US states who receive health insurance through their employers. Changes in use of preventive services, nonelective care, elective procedures, prescription drugs, in-person office visits, and telemedicine visits were examined during the first 2 months of the COVID-19 pandemic in 2020 relative to existing trends in 2019 and 2018. Disparities in the association of the pandemic with health care use based on patient’s zip code–level race and income were also examined. Results Data from 5.6, 6.4, and 6.8 million US individuals with employer-sponsored insurance in 2018, 2019, and 2020, respectively, were analyzed. Patient demographics were similar in all 3 years (mean [SD] age, 34.3 [18.6] years in 2018, 34.3 [18.5] years in 2019, and 34.5 [18.5] years in 2020); 50.0% women in 2018, 49.5% women in 2019, and 49.5% women in 2020). In March and April 2020, regression-adjusted use rate per 10 000 persons changed by −28.2 (95% CI, −30.5 to −25.9) and −64.5 (95% CI, −66.8 to −62.2) for colonoscopies; −149.1 (95% CI, −162.0 to −16.2) and −342.1 (95% CI, −355.0 to −329.2) for mammograms; −60.0 (95% CI, −63.3 to −54.7) and −118.1 (95% CI, −112.4 to −113.9) for hemoglobin A 1c tests; −300.5 (95% CI, −346.5 to −254.5) and −369.0 (95% CI, −414.7 to −323.4) for child vaccines; −4.6 (95% CI, −5.3 to −3.9) and −10.9 (95% CI, −11.6 to −10.2) for musculoskeletal surgery; −1.1 (95% CI, −1.4 to −0.7) and −3.4 (95% CI, −3.8 to −3.0) for cataract surgery; −13.4 (95% CI, −14.6 to −12.2) and −31.4 (95% CI, −32.6 to −30.2) for magnetic resonance imaging; and −581.1 (95% CI, −612.9 to −549.3) and −1465 (95% CI, −1496 to −1433) for in-person office visits. Use of telemedicine services increased by 227.9 (95% CI, 221.7 to 234.1) per 10 000 persons and 641.6 (95% CI, 635.5 to 647.8) per 10 000 persons. Patients living in zip codes with lower-income or majority racial/ethnic minority populations experienced smaller reductions in in-person visits (≥80% racial/ethnic minority zip code: 200.0 per 10 000 [95% CI, 128.9-270.1]; 79%-21% racial/ethnic minority zip code: 54.2 per 10 000 [95% CI, 33.6-74.9]) but also had lower rates of adoption of telemedicine (≥80% racial/ethnic minority zip code: −71.6 per 10 000 [95% CI, −87.6 to −55.5]; 79%-21% racial/ethnic minority zip code: −15.1 per 10 000 [95% CI, −19.8 to −10.4]). Conclusions and Relevance In this cross-sectional study of a large US population with employer-sponsored insurance, the first 2 months of the COVID-19 pandemic were associated with dramatic reductions in the use of preventive and elective care. Use of telemedicine increased rapidly but not enough to account for reductions in in-person primary care visits. Race and income disparities at the zip code level exist in use of telemedicine.
【초록키워드】 COVID-19, coronavirus disease, primary care, pandemic, cross-sectional, COVID-19 pandemic, drugs, Population, Health, Patient, age, hemoglobin, women, race, change, Care, association, COVID-19 epidemic, Analysis, disparity, demographics, reduction, Health Service, Musculoskeletal, 95% CI, individual, participant, finding, professional, Affect, state, objective, setting, initial, Result, analyzed, examined, significantly, reduced, majority, changes in, reductions in, changed, Importance, receive, in-person visit, offset, Point, Relevance, telemedicine visit, 【제목키워드】 COVID-19, Population, change, service,