The Effect of Primary Household Language on Well Child Care Utilization During the COVID-19 Pandemic

Background: The COVID-19 pandemic disrupted well child care nationally, leading to decreased primary care visits and routine childhood vaccinations. Children in limited English proficiency (LEP) households experience disparities in access to well child care; however, little is known about the impact of the COVID-19 pandemic on these disparities. We aimed to assess if patients’ primary household language was associated with 1.) changes in well child care utilization after the pandemic onset; and 2.) the rate of recovery towards pre-pandemic utilization.

Methods: Secondary analysis was conducted on medical records data from 4 clinics in a large urban university health system to determine the number of 1.) well child visits; 2.) vaccines administered; 3.) developmental delay diagnoses; and 4.) audiology referrals (proxy for developmental screening/referral) in patients 9-36 months old between January 2019-December 2020. Data was aggregated monthly by household primary language: limited English proficiency, Spanish (LEP-Spanish) vs. English. Differences between the pre-pandemic and pandemic periods (onset defined as March 2020) in 1.) well child care utilization and 2.) rate of recovery towards pre-pandemic utilization by primary household language were analyzed using Poisson linear regression.

Results: 8504 well child encounters occurred during this time period: 6615 in English-speaking patients, 1747 in LEP-Spanish speaking patients, and 142 in patients with other primary languages. After the pandemic onset, there was a decrease in well visits per month in both English (46% decrease, p<.001) and LEP-Spanish (61% decrease, p<.001) speaking patients (Fig. 1, Table 1). This decrease was significantly greater in the LEP-Spanish group (p <.001). Average number of vaccines administered per month also decreased in both English (44% decrease, p<.001) and LEP-Spanish (56% decrease, p<.001) speaking patients; the decrease was significantly greater in the LEP-Spanish group (p <.001). There was no evidence of recovery in either language group during the pandemic period for well child visits or vaccines administered. Between the pre-pandemic and pandemic periods, there was a significant increase in developmental delay diagnoses in LEP-Spanish speaking patients only (p=.001); both the English (p <.001) and LEP-Spanish (p=.02) groups had significant decreases in audiology referrals.

Conclusion: While well child care utilization decreased after the onset of the COVID-19 pandemic in all patients, LEP-Spanish speaking patients had disproportionately larger decreases in total number of well child visits and vaccines administered, as well as significantly higher diagnoses of developmental delay compared to primarily English-speaking patients. These findings suggest the need to focus outreach efforts and resources on patients with LEP to reduce healthcare disparities amplified by the COVID-19 pandemic. Further research is needed to identify barriers facing LEP patients in accessing well child care, as well as to evaluate the impact of the pandemic on other language groups.