Indirect Effects of the COVID-19 Pandemic on Well-Child Visits in Low-Income Children in Oklahoma.

Abstract

Context: During the COVID-19 pandemic, well-child visits were widely delayed or missed. Delays in routine care are more likely for low-income individuals and families who already face barriers to attending visits. Studies in the literature indicate declines in well-child visits during the pandemic but few have focused on low-income children and none have examined children in Oklahoma.

Objective: To evaluate changes in well-child visit attendance during the COVID-19 pandemic in low-income children residing in Oklahoma.

Design and setting: This retrospective cohort study used data from the Oklahoma Health Care Authority before COVID-19 emergence (March 1, 2017-July 31, 2019) and during the COVID-19 pandemic (March 1, 2020-July 31, 2022).

Participants: We studied children under 1 year of age attending well-child visits.

Main outcome measures: We calculated percentage change in the total number of well-child visits before and during the pandemic, including different phases and months during the pandemic. Log-binomial regression was performed with unique children who attended 6 or more well-child visits or less than 6 well-child visits before COVID-19 emergence or during the pandemic.

Results: We analyzed 194 126 children under 1 year of age attending 778 483 well-child visits. There was a 10.43% decrease in the total number of well-child visits during the COVID-19 pandemic compared to before it began, with a 5.18% decrease during the initial impact phase, 5.99% decrease during the initial recovery phase, 1.14% decrease during Delta variant predominance, and 13.79% decrease during Omicron variant predominance. Besides American Indian children, all other races were less likely to attend 6 or more well-child visits during the pandemic compared to before it began.

Conclusion: We observed declines in well-child visits during the COVID-19 pandemic with evident racial disparities. Catch-up efforts are essential to return to pre-pandemic levels of well-child visit attendance.