Study shows that preventive healthcare for people aged 50+ was most affected during the first wave of the pandemic

The first wave of the COVID-19 pandemic in 2020 affected preventive healthcare, including cancer diagnosis, according to a study by a team of researchers from the University of Coimbra (UC). The study analysed data from 123,000 people aged 50 and over from 28 countries, the vast majority of the European Union.

By analysing the impact of subjective unmet healthcare needs (SUN) in 2020 on people's health outcomes in 2021, the research highlights how pandemic crises can affect health systems, particularly the timely diagnosis of serious illnesses. To date, studies on the association between SUN and health outcomes are scarce, and the few that do exist with recent data use information from non-European countries.

Researchers Carlota Quintal, Micaela Antunes, Luís Moura Ramos, and Óscar Lourenço from the Centre for Business and Economics Research (CeBER) and professors at the Faculty of Economics of the University of Coimbra (FEUC) establish a correlation between unmet subjective health needs during the first wave of the pandemic in 2020 and the reporting of cancer diagnoses in 2021.

Unmet healthcare needs occur when there is a disparity between the health services that individuals believe they need (based on their perceptions or those of others) and the health services they actually receive. They are used as indicators of access to healthcare by the World Health Organization (WHO) and the Organisation for Economic Co-operation and Development (OECD).

"During the COVID-19 pandemic, SUN levels reached unprecedented levels in 2020," the team notes, adding that "in addition to the foregone healthcare due to fear of SARS-CoV-2 infection, health services also cancelled many planned care appointments".

In the scientific article Unmet healthcare needs among the population aged 50+ and their association with health outcomes during the COVID-19 pandemic, published in the European Journal of Ageing, the researchers analysed data from the Survey of Health, Ageing and Retirement in Europe (SHARE), which covered a population of people aged 50 and over from all 28 European Union countries (except Ireland), as well as Switzerland and Israel.

This database contains data on 123,000 individuals, including demographic, socio-economic, health, and family structure information.

The UC professors analysed three reasons for the occurrence of unmet health needs: 1) postponed pre-scheduled medical appointments (the most common reason, with 25% and 12% of people reporting at least one situation between 2020 and 2021, respectively); 2) foregone care due to fear of contracting COVID-19 (12% of people reported this at least once in 2020 and 9% in 2021); 3) unanswered requests for appointments (5% in both 2020 and 2021).

A lesson for the future is that a better balance needs to be struck between caring for patients affected by a pandemic and ensuring that other patients receive the preventive care most likely to affect their health, say the researchers.

The team explains: "The study does not suggest that SUN led to cancer, but rather that in 2020 people missed relevant screening tests and may have experienced delayed diagnoses". Nevertheless, the professors clarify: "The results suggest that health systems did not withhold care from those most at risk. They further add that "We observed a negative association between SUN and mortality, suggesting that health systems prioritised individuals with life-threatening conditions. This demonstrates the ability to identify and prioritise access to those at higher mortality risk, even in a challenging and unprecedented context".

The dimension of care most affected is preventive services. “Our analysis suggests that the likelihood of a new cancer diagnosis (including cancers or malignancies such as leukaemia or lymphoma, excluding minor skin cancers) in 2021 is higher among people who had their healthcare cancelled or denied in 2020, or who skipped appointments or screenings out of fear,” the researchers explain.

This study “does not suggest that these appointments or screenings could have prevented a cancer diagnosis, but rather that if these individuals had not experienced unmet healthcare needs in 2020, they could have been diagnosed earlier,” explain Carlota Quintal, Micaela Antunes, Luís Moura Ramos, and Óscar Lourenço. “Time is crucial in terms of cancer-related morbidity and mortality,” they emphasise.

In the Portuguese context, according to data from another study by the same research team, "60% of respondents to the Survey of Health, Ageing and Retirement in Europe in 2020 had at least one SUN, with cancellation by health services being the most common reason," the professors point out. Considering the magnitude of the Portuguese SUN phenomenon during the first wave of the pandemic, the reported results are worrying and suggest cases of delayed cancer diagnosis," they add.

"A lesson for the future is that a better balance needs to be struck between caring for patients affected by a pandemic and ensuring that other patients receive the preventive care most likely to affect their health”, the research team concludes.

The scientific article is available here