Racial and Ethnic Differences in Factors Associated With Delayed or Missed Pediatric Preventive Care in the US Due to the COVID-19 Pandemic

Importance: The COVID-19 pandemic has disrupted medical care use. Yet information on how the pandemic has affected pediatric preventive care use in the US is lacking. Objective: To examine the prevalence of and risk and protective factors for delayed or missed pediatric preventive care in the US due to the COVID-19 pandemic, further stratified by race and ethnicity to assess associations by groups. Design, Setting, and Participants: This cross-sectional study used data from the 2021 National Survey of Children's Health (NSCH) collected between June 25, 2021, and January 14, 2022. Weighted data from the NSCH survey are representative of the population of noninstitutionalized children aged 0 to 17 years in the US. For this study, race and ethnicity were reported as American Indian or Alaska Native, Asian or Pacific Islander, Hispanic, non-Hispanic Black, non-Hispanic White, or multiracial (≥2 races). Data analysis was performed on February 21, 2023. Exposures: The Andersen behavioral model of health services use was used to assess predisposing factors, enabling factors, and need factors. Main Outcomes and Measures: The main outcome was delayed or missed pediatric preventive care due to the COVID-19 pandemic. Bivariate and multivariable Poisson regression analyses were performed using multiple imputation with chained equations. Results: Of the 50 892 NSCH respondents, 48.9% were female and 51.1% were male; their mean (SD) age was 8.5 (5.3) years. With regard to race and ethnicity, 0.4% were American Indian or Alaska Native, 4.7% were Asian or Pacific Islander, 13.3% were Black, 25.8% were Hispanic, 50.1% were White, and 5.8% were multiracial. More than one-fourth of children (27.6%) delayed or missed preventive care. In multivariable Poisson regression using multiple imputation, Asian or Pacific Islander children (prevalence ratio PR, 1.16 95% CI, 1.02-1.32), Hispanic children (PR, 1.19 95% CI, 1.09-1.31), and multiracial children (PR, 1.23 95% CI, 1.11-1.37) were more likely to have delayed or missed preventive care compared with non-Hispanic White children. Among non-Hispanic Black children, risk and protective factors included age 6 to 8 years (vs 0-2 years PR, 1.90 (95% CI, 1.23-2.92)) and difficulty covering basic needs somewhat or very often (vs never or rarely PR, 1.68 (95% CI, 1.35-2.09)). Among multiracial children, risk and protective factors included age 9 to 11 years (vs 0-2 years PR, 1.73 (95% CI, 1.16-2.57)), lower household income (<100% vs ≥400% federal poverty level: 0.52 0.35-0.79), and 2 or more vs 0 health conditions (PR, 1.54 95% CI, 1.14-2.08). Among non-Hispanic White children, risk and protective factors included older age (9-11 years vs 0-2 years PR, 2.05 (95% CI, 1.78-2.37)), 4 or more children vs 1 child in the household (PR, 1.22 95% CI, 1.07-1.39), fair or poor vs excellent or very good caregiver health (PR, 1.32 95% CI, 1.18-1.47), difficulty covering basic needs somewhat or very often (vs never or rarely PR, 1.36 (95% CI, 1.22-1.52)), good vs excellent or very good perceived child health (PR, 1.19 95% CI, 1.06-1.34), and 2 or more vs 0 health conditions (PR, 1.25 95% CI, 1.12-1.38). Conclusions and Relevance: In this study, the prevalence of and risk factors for delayed or missed pediatric preventive care varied by race and ethnicity. These findings may guide targeted interventions to enhance timely pediatric preventive care among different racial and ethnic groups.