Accessing Healthcare During the COVID-19 Pandemic: Experiences of NYC residents living in North and Central Brooklyn, the South Bronx, and East and Central Harlem

Abstract

AbstractBackgroundThe COVID-19 pandemic has disproportionately affected some New York City (NYC) neighborhoods that primarily consist of Black, Indigenous, and Latino residents. This has been attributed to a longstanding history of structural racism and disinvestment in these communities, resulting in chronic and infectious disease inequities. To help address these health inequities, the NYC Department of Health and Mental Hygiene have utilized placed-based approaches and operated within NYC’s most affected neighborhoods of North and Central Brooklyn, South Bronx, and East and Central Harlem. During the pandemic, these neighborhoods experienced high hospitalization and COVID-related death rates when compared to the rest of NYC. While stay-at-home orders were implemented to reduce the spread of COVID-19, this may have also affected utilization of non-COVID related healthcare services.MethodsTo assess the impact of the pandemic on health and social conditions, the NYC Health Department administered the COVID-19 Community Recovery Survey from September 30, 2021 to November 4, 2021, to 1,358 residents in a subset of these neighborhoods. The survey aimed to assess the prevalence of and reasons for delaying non-COVID related healthcare services during the first 18 months of the pandemic. Quantitative analyses were conducted in SAS Enterprise Guide 7.115 and SAS-Callable SUDAAN and weighted with 2015-2019 American Community Survey 5-year estimates. Qualitative analyses were conducted in Microsoft Excel.ResultsMore than half of participants (54%) delayed routine healthcare or mental health services. Fear of contracting COVID-19 (61%), stay-at-home policies (40%), belief that care could safely be postponed (35%), and appointment challenges (34%) were among reasons for delaying routine healthcare. Fear of contracting COVID-19 (38%) and reduced hours of service (36%) were primary reasons for delaying mental healthcare. Reported reasons for the sustained delay of care past 18 months involved COVID concerns, appointment, and insurance challenges.ConclusionsThe delay of non-COVID related healthcare throughout the pandemic may result in the further widening of the health inequity gap among NYC residents dealing with a higher chronic disease burden before the start of the COVID-19 pandemic in March 2020. Findings from this study can support equitable COVID-19 recovery and guide efforts with health promotion.