Have Texans Been Skipping or Postponing Medical Care During the COVID-19 Pandemic? Major Takeaways From a Recent Statewide Poll

Shao-Chee Sim
Episcopal Health Foundation

During the COVID-19 pandemic, a time when our personal and community health should take center stage, Texans have been skipping or delaying medical care. That’s according to the Episcopal Health Foundation’s (EHF’s) Texas COVID-19 Survey report released late last year. This finding is significant because delay or avoidance of medical care might increase Texans’ risk of serious illness or death due to preventable or treatable health conditions.

This EHF study from August-September 2020 backs the results of two earlier national reports. The Kaiser Family Foundation (KFF) Health Tracking Poll in May 2020 found that close to half of adults said they or someone in their household postponed or skipped medical care due to the pandemic. The Centers for Disease Control and Prevention estimated 41% of Americans delayed or avoided seeking medical care as of June. Both reports documented the impact of the pandemic on Americans’ seeking of medical care early in the pandemic. 

The EHF survey is the first-ever statewide survey to capture COVID-19’s influence on Texans’ medical care-seeking behavior (See the EHF report’s methodology.) 

What does the EHF COVID-19 Survey find?

More than one-third of Texans (36%) say they or someone in their household have skipped or postponed some type of medical treatment because of COVID-19. One-third of Texans skipped or postponed preventive care like wellness visits, cancer screenings, blood pressure and cholesterol tests, drugs/alcohol counseling, and vaccines. A small percentage also sidestepped diagnostic care like tests, office visits, and procedures needed to diagnose or monitor a disease. Make no mistake, 36% is a big percentage of people not going to the doctor when they should. 

The survey also revealed other troubling patterns. Almost three-quarters of respondents skipped or postponed both regular check-ups and dental check-ups as part of their preventive care. Nearly one-third (30%) put off preventive screenings and immunizations for their child. Nearly the same amount of people (28%) missed or put off seeing their physician for chronic, ongoing conditions. While the survey shows smaller groups of Texans are neglecting more serious medical procedures like surgery (17%) and cancer treatment (4%), delaying care for chronic conditions can be dangerous. 

Do race/ethnicity, household income, and educational level matter in explaining Texans’ medical care-seeking behavior during the pandemic?

Yes, apparently people of different incomes and race/ethnicity adopted different habits about seeking health care during the pandemic. For example, Hispanic Texans were more likely to say they skipped or postponed cancer treatments than white Texans (9% vs. 3%). (The number of responses from Black Texans was too small to ensure statistical accuracy.) 

EHF also found that households with annual income less than $75,000 are more likely to skip or delay doctor visits for chronic conditions such as diabetes and high blood pressure than households with higher income (34% vs. 21%). 

Texans with less than a college degree are more likely to skip or postpone doctor visits for chronic conditions than their counterparts with a college degree or more (34% vs. 17%). (See Tables One, Two, and Three for details.)

So what does this tell us about the health of Texans?

As the pandemic continues, it is disconcerting that six months after the pandemic started, more than one-third of Texans were still skipping or delaying medical care, and 70% of those who skipped medical care were putting off their medical and dental check-ups or exams. 

Some ethnic minorities have been more likely to skip or postpone cancer treatments, and Texans with fewer resources and less education are more likely to delay doctor visits for their chronic conditions. 

We already knew that avoiding preventive care and delaying addressing health issues might lead to bigger, more serious health problems in the future. That is why it is important to conduct further research to better understand the underlying reasons why Texans have been avoiding medical care and to study whether and in what ways telehealth/telemedicine can address these medical care needs. 

   

The pandemic has caused tremendous disruptions in our society. Knowing the enormous health, economic, and social costs of continuing to defer medical care, the survey findings serve as an important reminder for policymakers, regulators, medical professionals, and public health communities to develop policies and programs that encourage Texans to seek appropriate and timely medical care. 

If Texans prioritize our general health needs as we fight to avoid COVID-19 (by socially distancing, wearing masks, and washing hands frequently), we not only boost the overall health of our community but also we avoid suffering other health problems as the number of COVID-19 cases in the state continues to increase.

Table One: Type of Medical Care Skipped or Delayed by Texans Due to COVID-19 by Race/Ethnicity

	Total	White	Hispanic	Black
Skipped or postponed regular check-ups of exams	69%	66%	70%	77%
Skipped or postponed dental check-ups of exams	70%	68%	73%	65%
Preventative screenings such as mammograms, colonoscopies, or other screenings	38%	41%	37%	31%
Doctor visits for chronic conditions such as diabetes and high blood conditions	28%	29%	29%	25%
Doctor visits for symptoms you were experiencing	39%	37%	44%	43%
Reproductive health care visits	20%	18%	23%	15%
Immunizations for your child or other child wellness visits	30%	23%	30%	28%
Mental health care	19%	22%	17%	12%
Physical therapy or rehabilitation care	17%	14%	21%	16%
Surgery	17%	16%	18%	11%
Cancer treatments*	4%	3%	9%	1%

*Denotes statistically significant difference between Hispanic Texans and White Texans at p<.05

Table Two: Type of Medical Care Skipped or Delayed by Texans Due to COVID-19 by Household Income

	Total	Under $75K	$75K +
Skipped or postponed regular check-ups of exams	69%	71%	70%
Skipped or postponed dental check-ups of exams	70%	69%	71%
Preventative screenings such as mammograms, colonoscopies, or other screenings	38%	37%	39%
Doctor visits for chronic conditions such as diabetes and high blood conditions*	28%	34%	21%
Doctor visits for symptoms you were experiencing	39%	43%	38%
Reproductive health care visits	20%	33%	29%
Immunizations for your child or other child wellness visits	30%	26%	16%
Mental health care	19%	19%	15%
Physical therapy or rehabilitation care	17%	18%	15%
Surgery	17%	19%	16%
Cancer treatments	4%	5%	4%

*Denotes statistically significant difference between Households with income less than $75K and households with income more than $75K at p<.05.

Table Three: Type of Medical Care Skipped or Delayed by Texans Due to COVID-19 by Educational Level

	Total	Less than college	College+
Skipped or postponed regular check-ups of exams	69%	68%	73%
Skipped or postponed dental check-ups of exams	70%	68%	72%
Preventative screenings such as mammograms, colonoscopies, or other screenings	38%	36%	42%
Doctor visits for chronic conditions such as diabetes and high blood conditions*	28%	34%	17%
Doctor visits for symptoms you were experiencing	39%	43%	33%
Reproductive health care visits	20%	18%	25%
Immunizations for your child or other child wellness visits	30%	31%	29%
Mental health care	19%	17%	23%
Physical therapy or rehabilitation care	17%	19%	14%
Surgery	17%	18%	16%
Cancer treatments	4%	6%	2%

*Denotes statistically significant difference between Texans with less than a college degree and Texans with a college degree at p<.05.