COVID-19 Exacerbated Healthcare Utilization Disparities for People With Disabilities

New research has found that adults in the United States (US) with disabilities experienced increased delays in medical care and declines in cardiovascular screenings during the COVID-19 pandemic compared to those without disabilities, continuing a pattern of healthcare utilization disparity.1,2

“While research has examined COVID-19’s impact on healthcare utilization for people with disabilities, many studies lack disability-specific surveillance, limiting understanding of how different disability types were affected. Investigating preventive screening trends before and during the pandemic is crucial to distinguishing temporary disruptions from persistent structural inequities. Addressing these gaps is essential for developing inclusive healthcare strategies for future public health emergencies,” lead investigator Annaliese Pena, Department of Epidemiology, College of Health Sciences, University of Delaware, and colleagues wrote.1

Pena and colleagues examined healthcare utilization and preventive cardiovascular (CV) health screening between 2021 and 2023 compared to pre-pandemic year 2019 among participants included in the cross-sectional analysis, stratified by disability status. The analysis drew from data from National Health Interview Survey and included 150,198 adults that had either sensory, cognitive, physical, multiple, or no disability.

Data on healthcare utilization measures, including usual care source, wellness visits, and delayed/unmet care due to cost, and preventive screenings, including blood pressure, cholesterol, glucose, and flu-shot, were analyzed using descriptive methods and Poisson regression.

The investigators found that during the COVID-19 pandemic, CV health screening rates decreased across all disability types except sensory disability. Specifically, blood pressure screening for adults with cognitive disabilities dropped from 89% in 2019 to 83% in 2021, and blood glucose screening for those with multiple disabilities declined from 83.9% to 78.4%.1

Pena and colleagues also found that cholesterol screenings decreased across all disability types in 2021 but increased among adults with sensory disabilities in 2023 (adjusted rate ratio [ARR], 1.07 [95% CI, 1.03-1.09]). Importantly, they found that adults with cognitive (ARR, 1.23 [95% CI, 1.03-1.43]) and physical (ARR, 1.13 [95% CI, 1.01-1.27]) disabilities reported higher unmet medical needs due to cost compared to those without disabilities. These differences persisted even after adjusting for pandemic related socioeconomic changes, including income, citizenship, employment, and insurance.1

“[These findings highlight] ongoing disparities in healthcare utilization [and]… underscore the urgent need for public health initiatives to enhance preventive health screening uptake among adults with disabilities,” Pena and colleagues concluded.1

Other recent research on CV screening was presented at the 9 Annual Heart in Diabetes Conference in Philadelphia, PA, by Mohammad Shahzeb Khan, MD, an assistant professor of medicine at Baylor College of Medicine, from a pooled cohort analysis comparing methods of measuring risk of heart failure (HF) in patients with type 2 diabetes without atherosclerotic cardiovascular disease (ASCVD).3

Khan and colleagues found that 1-step screening strategies like NT-proBNP resulted in a lot of missed heart failure events, missing, for example, almost 30-40% of the heart failure events that were occurring in low risk NT-proBNP growth. On the other hand, combination screening, such as with NT-proBNP and the WATCH-DM score, resulted in a much lower percentage of patients missed between all 6 included cohorts, which were drawn from various previous studies, including the Atherosclerosis Risk in Communities (ARIC) and Chronic Renal Insufficiency Cohort (CRIC) studies, and included 6293 patients.

“The most important takeaway for this is that using 1-step screening strategies might not be enough to screen for patients with heart failure,” Khan told HCPLive. “We’ll have to use a layered strategy, at least 2-step screening in which, for earlier stratification, you can use a risk score like WATCH-DM and then use a biomarker selectively.”

Watch the full conversation with Khan by clicking here.

REFERENCES

1. Pena A, Bauman P, Free P, et al. Healthcare Utilization and Preventive Cardiovascular Health Screening Among Adults with Disabilities Amid COVID-19 Phases. Am J Preventive Med. Published online May 1, 2025:107648-107648. doi: 10.1016/j.amepre.2025.107648

2. Study Reveals COVID-19 Deepened Health Disparities for Adults with Disabilities. News release. University of Delaware. July 2, 2025. https://www.newswise.com/articles/study-reveals-covid-19-deepened-health-disparities-for-adults-with-disabilities

3. Patel KV, Segar MW, Klonoff DC, et al. Optimal Screening for Predicting and Preventing the Risk of Heart Failure Among Adults With Diabetes Without Atherosclerotic Cardiovascular Disease: A Pooled Cohort Analysis. Circulation. 2024;149(4):293-304. doi:10.1161/CIRCULATIONAHA.123.067530