Aging
COVID-Related Healthcare Disruptions and Subsequent Impacts on Chronic Disease Management among Older Adults with Multiple Chronic Conditions Receiving Care in the New York City Safety-Net Healthcare System Sarah Conderino* Sarah Conderino John A. Dodson Yuchen Meng Rania Kanchi Jasmin Divers Samrachana Adhikari Saul Blecker Rajesh Vedanthan Nichola Davis Stan Kogan Karyn Singer Hannah Jackson Andrew Wallach Theodore Long Mark G. Weiner Lorna E. Thorpe
Background: The COVID-19 pandemic had a significant impact on healthcare delivery. Older adults with multimorbidities were particularly vulnerable to disruptions in care for the management of their chronic conditions. Our goal was to characterize healthcare disruptions and effects on disease management among older adults with multimorbidities who were patients of NYC Health + Hospitals, the largest safety-net system in the country.
Methods: The study population included NYC residents aged 50 or older with multimorbidities who had at least one ambulatory visit in the 6 months before COVID-19 pandemic onset (3/6/2020). We descriptively identified independent predictors of disruption in care during the first 7 months of the pandemic and estimated the effect of disruption in care on blood pressure control, HbA1c and low-density lipoprotein cholesterol (LDL) using difference-in-differences models. Inverse probability weighting was used to improve exchangeability between those with disruption in care vs. those with some care.
Results: A total of 90,718 older adult patients with multimorbidities were seen within the 6 months prior to the COVID-19 pandemic, 17.9% of whom received no care during the first 7 months of the pandemic. Poor baseline health status, low pre-pandemic healthcare utilization and older age were independent predictors of disruption in care. Compared to those who received care, the total disruption group had a 2.7% greater decrease in blood pressure control (67.4% to 59.0% vs. 69.5% to 63.8%). Disruption did not have a significant impact on mean HbA1c or LDL levels.
Conclusions: Total disruption in care was associated with declines in blood pressure control that, while clinically modest, would have an impact on cardiovascular outcomes at the population level. Implementation of telehealth may have mitigated impacts of the pandemic on care disruption and subsequent disease biomarkers. Targeted outreach during future crises is needed to improve access to care.