Associations of the COVID-19 pandemic with older individuals’ healthcare utilization and self-reported health status: a longitudinal analysis from Singapore

Background The COVID–19 pandemic has challenged the capacity of healthcare systems around the world and can potentially compromise healthcare utilization and health outcomes among non-COVID–19 patients. Objectives To examine the associations of the COVID-19 pandemic with healthcare utilization, out-of-pocket medical costs, and perceived health among middle-aged and older individuals in Singapore. Method Utilizing data collected from a monthly panel survey, a difference-in-differences approach was used to characterize monthly changes of healthcare use and spending and estimate the probability of being diagnosed with a chronic condition and self-reported health status before and during the COVID-19 outbreak in 2020. Subjects Data were analyzed from 7569 nationally representative individuals from 2019 January and 2020 December. Measures Healthcare utilization and healthcare spending by medical service categories as well as self-reported health status. Results Between January and April 2020 (the first peak period of COVID-19 in Singapore), doctor visits decreased by 30%, and out-of-pocket medical spending decreased by 23%, mostly driven by reductions in inpatient and outpatient care. As a result, the probability of any diagnosis of chronic conditions decreased by 19% in April 2020. The decreased healthcare utilization and spending recovered after lifting the national lockdown in June, 2020 and remained similar to the pre-pandemic level through the rest of 2020. Conclusions Middle-aged and older Singaporeans’ healthcare utilization and the diagnosis of chronic conditions substantially decreased during the first peak period of the COVID-19 outbreak. Further studies to track the longer-term health effect of the pandemic among non-COVID-19 patients are warranted.

Food Protein-Induced Enterocolitis Syndrome: Healthcare Utilization and Referral Patterns Among a Pediatric Cohort

BACKGROUND: Food protein–induced enterocolitis syndrome (FPIES) is a non-IgE mediated food allergy characterized by delayed, repetitive vomiting. FPIES has gained attention over the last few years and is becoming better recognized; however, there remains a lag in diagnosis. This study aimed to further explore this lag in diagnosis, as well as referral patterns and healthcare utilization, to determine areas for earlier recognition. METHODS: Data was obtained through retrospective chart reviews of pediatric FPIES patients at two hospital systems in New York. Charts were reviewed for age of symptom onset, age of diagnosis, FPIES episodes and healthcare visits prior to diagnosis, and reason/source of referral to allergy. A cohort of patients with IgE-mediated food allergy was reviewed for comparison. RESULTS: In total, 110 patients with FPIES were identified. The median length to diagnosis was 3 months, compared to 2 months in IgE-mediated food allergy (p < 0.05). Most referrals were from the pediatrician (68%) or gastroenterology (28%), none were from the ED. The most common reason for referral was concern of IgE-mediated allergy (51%), followed by FPIES (35%). CONCLUSION: This study demonstrates a lag in the diagnosis of FPIES and a lack of recognition of FPIES outside of the allergy community, as only one-third of the patients were considered to have FPIES prior to an allergy evaluation. Patients with profuse, repetitive vomiting 1- 4 hours after food ingestion, especially of common FPIES trigger foods, should be considered for diagnosis of FPIES, as these encounters provide an opportunity for early recognition.