Racial Disparity in Disruption to Basic Needs Among Medicare Beneficiaries During the COVID-19 Pandemic

Trends in forgone medical care and unmet needs among Medicare beneficiaries with a history of depression during the COVID-19 pandemic: a national, repeated cross-sectional study

OBJECTIVES

To investigate trends in forgone medical care, basic needs disruption, financial and mental health disruption, engagement of preventive behaviours guidelines, and perceived severity of COVID-19 among community-living Medicare beneficiaries in the USA with and without a self-reported history of depression from Summer 2020 to Winter 2021.

DESIGN/SETTING

A repeated cross-sectional study using a nationally representative sample of Medicare beneficiaries of three rounds of survey data from the Medicare Current Beneficiary Survey COVID-19 Supplement Public Use Files: Summer 2020, Fall 2020 and Winter 2021.

PARTICIPANTS

A total of 28 480 community-dwelling Medicare beneficiaries.

MAIN OUTCOME MEASURES

Forgone medical care, basic needs disruption, financial and mental health disruption, engagement of preventive behaviours guidelines, and perceived severity of COVID-19.

RESULTS

In the study sample, 7629 (27%) had a history of depression. After adjusting for potential confounders, weighted multivariable logistic regression models showed that Medicare beneficiaries with a history of depression had higher odds of foregone medical care (OR: 1.29, 95% CI 1.16 to 1.42, p<0.001), of basic need disruption (OR: 1.49, 95% CI 1.33 to 1.67, p<0.001), and of financial and mental health disruption (OR: 1.75, 95% CI 1.60 to 1.91, p<0.001) during the COVID-19 pandemic when compared with those without a history of depression. No statistically significant differences were observed in engagement of essential preventive behaviours or perception of COVID-19 severity.

CONCLUSIONS

COVID-19 pandemic may exacerbate existing barriers to healthcare access and financial and social needs, possibly leading to persistent unmet needs among Medicare beneficiaries with a history of depression beyond the pandemic.

Association of Sources of COVID-19 Information With Vaccine Uptake, Preventive Behaviors, and Perceived Severity of COVID-19

OBJECTIVE

To investigate the association of using informal sources and reliance on multiple sources of information with actual COVID-19 vaccine uptake, the number of doses of vaccine received, COVID-19 testing, essential preventive measures, and perceived severity of COVID-19.

DESIGN

Retrospective cross-sectional study.

SETTING AND PARTICIPANTS

Our study sample consisted of 9584 community-dwelling Medicare beneficiaries, representing a weighted 50,029,030 beneficiaries from the Winter 2021 Medicare Current Beneficiary Survey COVID-19 Supplement.

METHODS

Two key independent variables were whether a respondent relied on a formal source (ie, traditional news, government guidance, or health care providers) or an informal source (ie, social media, Internet, or friends/family) the most for the COVID-19 information and the total number of information sources a respondent relied on.

RESULTS

Compared with beneficiaries relying on formal sources of information, those relying on informal sources of information were less likely to receive COVID-19 vaccine (odds ratio [OR], 0.65; 95% CI, 0.56-0.75) and COVID-19 testing (OR, 0.85; 95% CI, 0.74-0.98), to engage in preventive behaviors (OR, 0.61; 95% CI, 0.50-0.74), to have high perception of COVID-19 severity, and were more likely to be unvaccinated vs 2 doses of vaccine (relative risk ratio [RRR], 1.64; 95% CI, 1.41-1.91). Relying on more information sources was significantly associated with higher odds of actual vaccine uptake (OR, 1.21; 95% CI, 1.17-1.26), COVID-19 testing (OR, 1.11; 95% CI, 1.07-1.15), engagement of essential preventive behaviors (OR, 1.33; 95% CI, 1.25-1.42), having high perception of COVID-19 severity, and with lower likelihood of being unvaccinated vs 2 doses of vaccine (RRR, 0.82; 0.79-0.85).

CONCLUSIONS AND IMPLICATIONS

The COVID-19 pandemic has made communicating information about coronavirus more important than ever. Our findings suggest that information from formal sources with expertise and more balanced sources of information were key to effective communication to prevent from COVID-19 infection among older adults.