Trends in Pediatric Primary Care Visits During the Coronavirus Disease of 2019 Pandemic

Abstract

Objective

Months after the declaration of the coronavirus disease of 2019 (COVID-19) national emergency, visits among children remained suppressed for unclear reasons, which we sought to understand by examining child visit rates.

Methods

Using de-identified claims data for children <18 years old from OptumLabs® Data Warehouse, a large commercial claims database, we compared monthly primary care visit and vaccination rates from January–October 2020 to January–October 2018 and 2019. Visit rates were analyzed by visit reason and by the month after (eg, month +1) the COVID-19 public health emergency declaration using a series of child-level Poisson regression models.

Results

There were 3.4, 3.4, and 3.1 million children in 2018, 2019, and 2020 cohorts, respectively. Compared to the same months in prior years, primary care visits in 2020 were 60% lower in month +1 (incidence rate ratio [IRR] 0.40, 99% confidence interval [CI] 0.40–0.40) and 17% lower in month +7 (IRR 0.83, 99% CI 0.83–0.83). Preventive visit rates were 53% lower in month +1 (IRR 0.47, 99% CI 0.47–0.47), but 8% higher than prior years in month +7 (IRR 1.08, 99% CI 1.08–1.08). Monthly rates of vaccine administration followed a similar pattern. Problem-focused visits remained 31% lower in month +7 (IRR 0.69, 99% CI 0.68–0.69), with notably fewer infection-related visits (acute respiratory tract infections IRR 0.37, 99% CI 0.36–0.37; gastroenteritis IRR 0.20, 99% CI 0.20–0.20).

Conclusion

Seven months after the COVID-19 emergency declaration, receipt of pediatric care remained suppressed due to fewer problem-focused visits, with notably fewer infection-related visits. By October 2020, rates of preventive visits and vaccination exceeded rates in prior years.