Missed or Delayed Pediatric Preventative Care During COVID-19 Pandemic Influenced By Race, Enabling Factors


Study among the first to examine delayed or missed pediatric preventative care during COVID-19 that considers determinants, race, and ethnic group, according to the authors.

More than one-quarter of children (27.6%) missed or delayed a preventative check-up because of the COVID-19 pandemic, according to research published in JAMA Network Open. There were varying predisposing, enabling, and need factors associated with delayed care, and these differed based on variables, such as race and ethnicity.

Image credit: realstock1 - stock.adobe.com

Image credit: realstock1 - stock.adobe.com

Investigators conducted a cross-sectional study of data collected from 50,892 respondents who completed the 2021 National Survey of Children’s Health (NSCH) between June 25, 2021, and January 14, 2022. They primarily evaluated missed or delayed pediatric preventative check-up because of COVID-19, and they also evaluated this association with race and ethnicity.

Notable predisposing risk factors (based on genetics, life events) for missed or delayed appointments included older age (6 to 8 years compared to 0 to 2 years) or living in a household with more children. Investigators made a novel finding that caregiver health (graded as fair or poor vs excellent or very good) is a predisposing risk factor that “possibly reflect(s) concern over COVID-19 exposure or other accessibility barriers,” the study authors wrote.

Enabling factors were deemed as home ownership, household income, and the ability to cover basics such as food or housing, and needs factors were considered perceived child health and number of health conditions.

Specific risk factors for Black children were older age and financial hardship, whereas risk factors for non-Hispanic White children were older age, many children in the household, poor caregiver health, financial difficulties, and poor health. But, in general, Asian or Pacific Islander, Hispanic, and multiracial children were the most likely to have delayed or missed preventative care.

Among all children, lower household income was a protective factor for missed or delayed appointments. This was particularly true for multi-racial children, who instead had other specific risk factors such as older age, higher income, and poor health.

Study limitations included that respondents may be prone to recall or social desirability bias, leading to underestimation. In addition, the NSCH does not view delayed or missed preventative care as separate entities. Some caregivers did not follow a pediatric preventative care schedule and the research cannot determine causality.

During the years of the COVID-19 pandemic, many patients had limited access to health care resources. Further, many did not go to health care settings for fear of disease exposure or due to financial hardships that decreased the amount of people who used health care resources.

“Improved understanding of the extent to which children in the US are receiving the care they need may help identify children who would benefit from programs and services to promote timely pediatric preventive care visits,” the study authors wrote.


Tabet M, Kirby R, Xaverius P, et al. Racial and Ethnic Differences in Factors Associated With Delayed or Missed Pediatric Preventive Care in the US Due to the COVID-19 Pandemic. JAMA Netw Open. 2023;6(7):e2322588. doi:10.1001/jamanetworkopen.2023.22588

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