Healthcare Access and Cardiovascular Risk Factor Management Among Working-Age US Adults During the Pandemic.

Background: Low-income working-age US adults disproportionately experienced healthcare disruptions at the onset of the COVID-19 pandemic. Little is known about how healthcare access and cardiovascular risk factor management changed as the pandemic went on, or if patterns differed by state Medicaid expansion status. Methods: Cross-sectional data from the Behavioral Risk Factor Surveillance System were used to compare self-reported measures of healthcare access and cardiovascular risk factor management among US adults aged 18-64 years in 2021 (pandemic) to 2019 (pre-pandemic) using multivariable Poisson regression models. We assessed for differential changes between low-income (<138% FPL) and high-income (>400% FPL) working-age adults by including an interaction term for income group and year. We then evaluated changes among low-income adults in Medicaid expansion versus non-expansion states using a similar approach. Results: The unweighted study population included 80,767 low-income and 184,136 high income adults. Low-income adults experienced improvements in insurance coverage (RR 1.10 [95% CI: 1.08-1.12]), access to a provider (RR 1.12 [1.09-1.14]), and ability to afford care (RR 1.07 [1.05-1.09]) in 2021 compared with 2019. While these measures also improved for high income adults, gains in coverage and ability to afford care were more pronounced among low income adults. However, routine visits (RR 0.96 [0.94-0.98]) and cholesterol testing (RR 0.93 [0.91-0.96]) decreased for low-income adults, while diabetes screening (RR 1.01 [0.95-1.08]) remained stable. Treatment for hypertension (RR 1.05 [1.02-1.08]) increased and diabetes focused visits and insulin use remained stable. These patterns were similar for high-income adults. Across most outcomes, there were no differential changes between low-income adults residing in Medicaid expansion versus non-expansion states. Conclusions: In this national study of working-aged adults in the US, measures of health care access improved for low- and high-income adults in 2021. However, routine outpatient visits and cardiovascular risk factor screening did not return back to pre-pandemic levels, while risk factor treatment remained stable. As many COVID-era safety net policies come to an end, targeted strategies are needed to protect healthcare access and improve cardiovascular risk factor screening for working-age adults.