COVID-19 Pandemic
Impact of the COVID-19 pandemic on routine childhood healthcare in Oklahoma Jessica Beetch* Jessica Beetch Laura Beebe Amanda Janitz Katrin Kuhn
Introduction: The COVID-19 pandemic disrupted routine healthcare for children, but its impact has not been thoroughly studied, especially in low-income populations. Apart from the direct effects of the pandemic, such as COVID-19-associated hospitalizations and deaths, children’s health was also indirectly impacted. After the emergence of the pandemic, there were disruptions to routine services leading to delays in screening, vaccination, and treatment. Low-income children and those living in low-income settings were at risk of prolonged delays in care and worse health outcomes during the pandemic. Oklahoma is a state with a high poverty rate, high vaccine hesitancy, and low health ranking compared to other states in the US. We hypothesized that these factors contributed to poor childhood routine care during the pandemic in Oklahoma. Given this, the objective of this research study was to examine the impact of the COVID-19 pandemic on routine childhood vaccination and well-child visits in populations in Oklahoma.
Methods: First, we used data from the Oklahoma State Immunization Information System on children 18 years of age and younger to evaluate changes in DTaP and MMR vaccination during the pandemic (March 1, 2020 to July 31, 2022) compared to before it began (March 1, 2017 to July 31, 2019). We calculated percentage change in total vaccine doses administered separately for DTaP and MMR vaccines overall and by pandemic phase. The phases were named initial impact (March 1, 2020 to September 30, 2020), initial recovery (October 1, 2020 to May 31, 2021), Delta variant predominance (June 1, 2021 to November 30, 2021), and Omicron variant predominance (December 1, 2021 to July 31, 2022), and were compared to previous years before the COVID-19 pandemic (pre-initial impact: March 1, 2019 to September 30, 2019, pre-initial recovery: October 1, 2018 to May 31, 2019, pre-Delta: June 1, 2019 to November 30, 2019, pre-Omicron: December 1, 2018 to July 31, 2019). Log-binomial regression was performed with a sub-cohort of unique children <1 to 11 months of age that received a single DTaP vaccine or more than one DTaP vaccine before and during the COVID-19 pandemic. Race, ethnicity and income were examined as potential effect modifiers and confounders.
Next, we utilized data on children enrolled in Oklahoma’s Medicaid (SoonerCare) from the Oklahoma Health Care Authority. We examined changes in well-child visits in low-income children under 1 year of age. Percentage change in well-child visits was calculated overall, by pandemic phase, and month. Log-binomial regression was performed with children <1 month of age at first recorded visit that attended 6 or more well-child visits or less than 6 well-child visits in their first year of life before and during the pandemic. SoonerCare recommends 6 well-child visits in the first year of life. Sex, race, and ethnicity were explored as potential effect modifiers and confounders. Statistical analyses were performed using SAS (version 9.4; SAS Institute) and a type 1 error rate of 0.05.
Results: We observed declines in Oklahoma in childhood DTaP and MMR vaccinations administered during the pandemic. Overall, there was a 16% decline in DTaP vaccines administered and 16.7% decline in MMR vaccines administered during the pandemic compared to before the pandemic began. There were declines in DTaP and MMR vaccination counts during all pandemic phases studied. initial impact: DTaP = -18.1%, MMR = -23.9%; initial recovery: DTaP = -12.4%, MMR = -13.6%; Delta variant predominance: DTaP = -9.9%, MMR = -8.9%; Omicron variant predominance: DTaP = -19.9%, MMR = -22.0%. Children receiving more than one dose of DTaP vaccine in their first year of life decreased during the pandemic (RR = 0.92, 95% CI: 0.92,0.93).
We also observed declines in well-child visit attendance for low-income children less than 1 year of age in Oklahoma during the pandemic. Overall, well-child visit attendance declined by 10.4% (initial impact: -5.2%; initial recovery: -6.0%; Delta variant predominance: -1.1%; Omicron variant predominance: -13.8%). Substantial declines occurred in the initial months of the pandemic (March: -7.2%; April: -17.9%; May: -7.3%). We found racial disparities in attending well-child visits for low-income children in Oklahoma. In all races besides American Indians, children attending the full number of recommended well-child visits was reduced during the pandemic.
Conclusion: Our findings contribute to the body of evidence on the indirect effects of the pandemic on low-income children and children living in low-income settings. The pandemic substantially disrupted routine childhood care, particularly in the early months and during Omicron predominance. Racial disparities were evident for well-child visit attendance during the pandemic. This research study advises guidance on preparedness and response efforts during future outbreaks or public health emergencies.