Educational differences in self-report of forgoing care during the COVID-19 pandemic in Denmark

During the COVID-19 pandemic healthcare systems worldwide were challenged. Forgoing care is a term used to describe cancellations and postponements in healthcare appointments, either initiated by the patient or the healthcare system. Level of education and access to social support may influence individual inclination to forgo care. The aim of this study was to investigate educational differences in self-reports of patient-initiated forgoing care during COVID-19, and whether social support modified this relationship. This cross-sectional study relied on data from the second survey of the Copenhagen Aging and Midlife Biobank study, a large Danish survey collected during spring 2021. Modification of the association between education and forgoing care by social support were studied through combined exposure variables, and by formal tests of interaction on a multiplicative and additive scale. Results indicated no educational differences in forgoing care, and tests of interaction showed no statistically significant modification by social support of the association between education and forgoing care during COVID-19. Regardless of educational level, limited access to either emotional support or practical support was associated with significantly higher odds of forgoing care, compared to having a long education and access to support. The results add to the ambiguous findings of previous studies on educational differences in forgoing care. The complexity of individual reasons for forgoing care, such as fear of infection, perceived severity of symptoms, and opinions of and concerns for relatives, may explain the finding of no educational gradient in forgoing care.