Socioeconomic inequalities in healthcare access during the COVID-19 pandemic in Kazakhstan

Objective Large-scale public health crises, such as the COVID-19 pandemic, can disrupt access to essential healthcare services and exacerbate existing inequalities. This study investigates barriers to healthcare access in Kazakhstan during the COVID-19 pandemic, with a focus on socioeconomic factors associated with failed access to healthcare. Methods A cross-sectional, face-to-face survey was conducted between June and July 2021 during the COVID-19 pandemic using a multistage stratified sampling approach to recruit 1,021 adults across Kazakhstan. Analyses were weighted to account for differential selection probabilities and calibrated to the national population distribution by region, urban/rural residence, sex, and age. Anticipated (hypothetical) and experienced barriers to COVID-19-related care were assessed descriptively. Failed access to healthcare was defined as the inability to obtain at least one needed healthcare service. Associations between socioeconomic factors and failed access to general healthcare services were examined using survey-weighted modified Poisson regression with a log link and robust variance estimation. Results Among the 991 respondents included in the final study sample, 753 (75.5%) reported needing at least one healthcare service during the pandemic; of these, 21.7% ( n = 164) failed to access at least one needed service. The most frequently inaccessible services included health products (e.g., eyeglasses, mobility aids, and basic medical supplies) (31.7%), emergency care (21.5%), and inpatient medical care (20.2%). Commonly reported COVID-19-related barriers included fear of infection (38.9%), fear of hospitalization and its consequences (24.7%), and concerns about income loss due to isolation (23.9%). In multivariable analysis, failed access to healthcare was significantly associated with having a chronic condition (ARR, 1.54; 95% CI, 1.14–2.07), being unemployed (ARR, 1.70; 95% CI, 1.12–2.57), and experiencing food insecurity (ARR, 1.34; 95% CI, 1.01–1.77). Conclusion Health system disruptions may disproportionately affect socioeconomically vulnerable populations. Strengthening social protection and ensuring continuity of essential healthcare services may help reduce inequalities in healthcare access during future public health emergencies.