PM1014: Impact of the COVID-19 Pandemic on Ambulatory Pediatric Cardiology Care by Race/ethnicity and Socioeconomic Status

Background: Racial/ethnic and socioeconomic status (SES) disparities in congenital heart disease outcomes are well documented. Whether the COVID-19 pandemic impacted access to ambulatory pediatric cardiology care differentially based on race/ethnicity or SES is unknown.

Methods: Visits scheduled for patients 0-18 years old were stratified by race/ethnicity and SES. Visits were categorized as scheduled, delayed completion (completed later than originally scheduled within 6 months), or incomplete (no visit within 6 months). SES was identified using the Childhood Opportunity Index, a census-tract level index encompassing education, health and environment, and social and economic indicators, and categorized into five levels (very low, low, moderate, high, very high). Changes were described overall, and comparisons were made between early pandemic, April 2020 (vs April 2019), and later in the pandemic, July 2020 (vs April 2020), using chi-square and logistic regression.

Results: Annual clinic volume fell 4.5% during the first pandemic year, from 18,725 (2019) to 17,866 (2020). Visits completed by non-white minority (NWM) patients decreased from 30% to 28%, p< 0.001. The proportion with public insurance remained constant, 33%, p=0.83. Telehealth accounted for 46% of visits during the pandemic (0.8% pre-pandemic), with higher use by white than NWM patients (49% vs 43%, p< 0.001). There were 57% fewer visits early in the pandemic (April 2020) compared to the prior year, and more visits were delayed or incomplete, 21% to 61%, p< 0.001. Visit volume in later in the pandemic (July 2020) was similar to the year prior, with more delayed/incomplete visits, 29% to 38%, p< 0.001. Visit completion varied by race/ethnicity (Figure 1), with differences seen between white vs NWM early pandemic (p=0.01). The magnitude of change in rates of visit completion by race/ethnicity was not statistically significant (April 2019 vs 2020, p for interaction=0.74; April vs July 2020, p for interaction=0.48). Incomplete visit rates also varied by SES (Figure 2), with more incomplete visits for patients of very low SES early pandemic (p < 0.001) and very high SES both early and later pandemic (p < 0.005). While very low and low SES combined had increased incomplete visits early pandemic (p=0.001), this difference was similar to the year prior (p for interaction=0.12). Patients of very low SES had significantly less telehealth visits during the pandemic (26% vs 34-38%, p=0.028).

Conclusion: Overall, NWM patients have higher rates of incomplete/delayed visits compared to whites. Patients of lower SES had more incomplete visits early in the pandemic. However, the magnitude of both these differences was not heightened by the pandemic. Telehealth visits have become a prominent part of ambulatory care, with higher completion rates by white patients and lower completion rates by patients of very low SES. Efforts to reduce lapses in care are needed across demographics to ensure equitable care delivery.