Job loss and lower healthcare utilisation due to COVID-19 among older adults across 27 European countries

Abstract

BackgroundOlder adults are at greater risk for becoming severely ill from COVID-19; however, the impact of the pandemic on their economic activity and non-COVID-19-related healthcare utilisation is not well understood. The aim of this study was to examine the prevalence and predictors of COVID-19-related unemployment and healthcare utilisation in a sample of older adults across 27 European countries.MethodsWe used data from the Survey of Health, Ageing and Retirement in Europe COVID-19 Survey, collected between June and August 2020. Participants (n=52 061) reported whether they lost a job, forwent medical treatment and whether their appointment was postponed due to COVID-19. Three-level models were estimated for each outcome to test the effects of individual, household and country-level characteristics.ResultsThe mean prevalence of reported job loss, and forgone and postponed medical care was 19%, 12% and 26%, respectively. Job loss was associated with female sex, lower education and household income, and older age in women. For example, the OR of job loss, comparing primary versus tertiary (college) education, was 1.89 (95% CI 1.59 to 2.26). Forgone and postponed medical care was associated with older age in men, female sex and higher education. At the country level, postponed medical care was associated with more stringent governmental anti-COVID measures.ConclusionJob loss and lower healthcare utilisation for non-COVID-19-related reasons were common among older adults and were associated with several sociodemographic characteristics. Job loss appeared to disproportionally affect already economically vulnerable individuals, raising concerns about the exacerbation of social inequalities.

Effect of the COVID-19 Pandemic on Cost-Related Prescription Nonredemption, Health care Seeking and Hospitalization in Hungary: A Nationally Representative Cross-Sectional Study

“…This gap has been significantly narrowed during the pandemic period, suggesting that elective interventions were mainly postponed. These Hungarian observations are not in line with the independence between education and health care use during the pandemic, as described in the EU [29] and in the Netherlands [50], but these results were similar to the main findings of the SHARE Corona Survey on 27 European countries' 50+ year-old population [45]. Furthermore, our investigation demonstrated the inverse relationship of CRPNR with education, which was exaggerated in the pandemic period.…”

“…The GP and specialist visits postponed due to the lockdown were the most frequent in Portugal (55%) and reached their lowest in Bulgaria (2%), with an EU average of 26%. However, patients who missed treatments due to fear of acquiring the COVID infection during the lockdown were the highest in Israel (27%) and the lowest in Slovenia and Spain (4%), with an EU average of 12% [29]. Although it is known that most EU countries did not modify out-of-pocket payments for medication during the pandemic lockdown [11], the pandemic impact on medication has not yet been reported.…”

COVID-19 and Unmet Healthcare Needs of Older People: Did Inequity Arise in Europe?

“…For instance, while Luxembourg and Portugal, reporting percentages of postponed treatments over 50%, cancelled all non-indispensable health care activities since the very beginning of the pandemic (15 and 16 March, respectively), there were no official governmental instructions to postpone non-urgent activity in Bulgaria, which is reflected in the below 2% share of postponed care declared [41]. Ksinan et al [42] also have shown that postponed medical care in older Europeans was associated, at country level, with more stringent governmental anti-COVID measures.…”

“…There is also evidence suggesting the existence of significant pro-rich inequity in needadjusted specialist visits in Poland [47] and Greece [35,45]. More recently, some inequity issues in access to health care have been detected in Greece for vulnerable groups, mostly related to individuals' insurance status and to important shortages in the supply of health professionals and modern equipment due to the Great Recession [42].…”

Hitting Close to Home: The Effect of COVID-19 Illness in the Social Environment on Psychological Burden in Older Adults

“…This group has been, and continuous to be, considered at risk for severe illness and mortality from COVID-19 infection (Shahid et al, 2020;Gerwen et al, 2021) and therefore has had to incorporate changes into their day to day life. Health policies have targeted older people in asking them to isolate and physically distance to avoid infection which, although successful in protecting from the virus, have had negative consequences of their own: Increased subjective social isolation (Peng and Roth, 2021), lower healthcare utilization (Ksinan Jiskrova et al, 2021), reduction of physical activities (Creese et al, 2020;Brown et al, 2021), and social interaction (Richter and Heidinger, 2020;Heid et al, 2021) as well as the ever increasing problem of loneliness (Carson et al, 2020;Entringer et al, 2020;Heidinger and Richter, 2020;Luchetti et al, 2020;Stolz et al, 2020;Krendl and Perry, 2021) have been reported as byproducts of COVID-19 safety measures. As these lifestyle changes have been previously linked to adverse mental health outcomes, it is not surprising that an increase in depression, anxiety and stress symptoms, and a general decline of mental health during the pandemic (Shahid et al, 2020;Gerwen et al, 2021) have been noted in multiple studies (Banks and Xu, 2020;Bailey et al, 2021;De Pue et al, 2021;Grolli et al, 2021;Tsoukalis-Chaikalis et al, 2021).…”