(229) Impact of COVID-19 on Obstetric and Gynecologic Healthcare Utilization in a Large US Claims Database

Publication Number: 560

Background: In 2020, the COVID-19 pandemic presented a significant burden on the U.S. healthcare system and led to widespread closures, understaffing, and lockdowns, limiting patients’ access to care. Delayed or missed care could have consequences for patient prognosis, such as delayed screening for cervical cancer or missed prenatal visits.

Objectives: To utilize data from a large health insurance claims database to investigate the effect of the COVID-19 pandemic on obstetric and gynecologic healthcare utilization and outcomes.

Methods: For each month of 2019 and 2020, women aged 18-45 years on the first of the month without prior claims for hysterectomy, sterilization, or menopause and who were enrolled for the entire month were identified in the HealthCore Integrated Research Database (HIRD). For each month, we calculated the proportion of women with a claim for each of the following encounter types: gynecologic exams, prenatal visits, pregnancy-related encounters, preterm births, and preeclampsia, eclampsia, or gestational hypertension (PEGH). For each month, we calculated the deviation from the expected 2020 counts by subtracting the 2020 proportion from the 2019 proportion and multiplying the difference by the 2020 denominator for that month

Results: For each month, at least 2.8 million qualifying women were identified. Throughout 2019, approximately 3% of women generated a claim for a gynecologic exam each month. In 2020, this number dropped to 0.5%-1.9% in March-May, with a total of 133,406 potentially missed or delayed gynecologic exams in 2020. In 2019-2020, ~4% of women generated a pregnancy-related claim each month, with a drop to 3.5%-3.7% in March-May 2020, with a total of 38,144 fewer pregnancy-related claims than expected in 2020. In 2019-2020, ~2% of women attended a prenatal visit in each month, with a slight drop in visits in April and May 2020, with a total of 18,473 fewer prenatal visits than expected in 2020. In 2019-2020, ~0.03% per month generated a claim for preterm birth, with drops to 0.02% in April and November, with a total of 912 fewer preterm births than expected in 2020. In 2019-2020, 0.09%-0.11% women per month generated a PEGH claim, with slightly higher monthly proportions in 2020, representing 494 additional cases than expected in 2020.

Conclusions: We observed patterns indicating disruption of access to care, particularly during the early spring of 2020, with the greatest disruption to gynecologic exams. Fewer preterm births were noted, along with a higher number of PEGH claims, potentially due to lifestyle changes, maternal COVID-19 infections, and pandemic stress. Future work could standardize by age and geographical location to account for potential demographic shifts, and include additional years of data.