Healthcare renunciation among Italian older adults during the COVID-19 pandemic: insights from the PASSI d’Argento surveillance system

During the COVID-19 pandemic, a noticeable decrease in medical care utilization occurred which may contribute to increased morbidity and mortality rates associated with treatable conditions. In Italy, severely impacted by the pandemic, a comprehensive data source on healthcare renunciation is essential for policy formulation and intervention strategies. This study used data from the PASSI d'Argento (PdA) surveillance system to investigate healthcare renunciation among people aged ≥65 years in Italy from August 2020 to December 2021 and to estimate the health and sociodemographic profiles associated with barrier-renunciation (due to service disruption) and refusal-renunciation (because of fear of contagion). A total of 4364 out of 10 827 individuals needing healthcare reported foregoing at least one medical visit or diagnostic test, with the major reasons being fear of COVID-19 contagion (33%) and service disruptions (29%). Sociodemographic inequalities existed: regression analysis revealed significant associations between healthcare renunciation and being female [adjusted prevalence ratio (aPR) 1.17, 95% CI: 1.08-1.26], reporting economic difficulties (aPR 1.15, 95% CI: 1.02-1.28), having two or more chronic conditions (aPR 1.18, 95% CI: 1.04-1.34), and having at least one sensory problem (aPR 1.13, 95% CI: 1.06-1.22). Compared to 2020, healthcare renunciation decreased in 2021. The relevant healthcare renunciation among elderly in Italy during the pandemic highlights widening health gaps and barriers to care access. Long-term monitoring tools are crucial to mitigate the pandemic's impact on public health, especially for vulnerable populations.