Health service inequalities during the COVID-19 pandemic among elderly people living in large urban and non-urban areas in Florida, US
Abstract
Objectives
Health inequalities were often exacerbated during the emerging epidemic. This study examined urban and non-urban inequalities in health services among COVID-19 patients aged 65 or above in US Florida from March 2 to May 27, 2020.
Methods
A retrospective time series analysis was conducted using individual patient records. Multivariable Poisson and logistic models were used to calculate adjusted incidence of COVID-19 and the associated rates of emergency department (ED) visits, hospitalizations and deaths.
Results
As of May 27, 2020, there were 13,659 elderly COVID-19 patients (people aged 65 or above) in Florida and 14.9% of them died. Elderly people living in small metropolitan areas might be less likely to be confirmed with COVID-19 infection than those living in large metropolitan areas. The ED visit and hospitalization rates decreased significantly across metropolitan statuses for both men and women. Those patients living in small metropolitan or rural areas were less likely to be hospitalized than those living in large metropolitan areas (35% and 34% versus 41%). Elderly women aged 75 or above living in rural areas had 113% higher adjusted incidence of COVID-19 than those living in large metropolitan areas, and the rates of hospitalizations were lower compared with those counterparts living in large metropolitan areas (29% versus 46%; OR: 0.37 [0.25-0.54]; p <0.001).
Conclusions
For elderly people living in US Florida, those who living in small metropolitan or rural areas were less likely to receive adequate health care than those who living in large or medium metropolitan areas during the COVID-19 pandemic.
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