Care delay during the COVID-19 pandemic in Germany – a cross-sectional online survey in the NAKO study
During the COVID-19 pandemic, non-COVID-19 related healthcare utilization declined in Germany, resulting in care delay, including delays and cancellations of routine, chronic, and even acute care. The aim of this study was to investigate factors (i.e. regional differences and participant characteristics) associated with care delay during the pandemic in Germany using a cross-sectional survey. In October 2022, a total of 117,466 participants from the German National Cohort (NAKO) study completed an online questionnaire on pandemic-related topics, including care delay during the COVID-19 pandemic. Regional differences and participant characteristics associated with care delay were assessed using (multilevel) logistic regression. One third of participants reported having experienced care delay. Care delay did not differ across the 13 federal states or 32 districts in Germany for which sufficient data were available. In the medical practice setting, care delay was nearly equally provider- and patient-related and was reported mostly for routine check-ups. In the hospital setting, care delay was predominantly provider-related and reported for newly occurring conditions. The odds for care delay were higher in females vs. males (odds ratio (OR): 1.30; 95% confidence interval (CI): 1.27–1.34), and in participants with vs. without chronic conditions (e.g. mental disorders, OR: 1.41, 95%CI: 1.36–1.46 or cardiovascular diseases, OR: 1.20 95%CI: 1.16–1.24) and decreased with age (e.g. 70 + vs. 50–59 years, OR: 0.59, 95%CI: 0.57–0.62). Care delay during the COVID-19 pandemic depended on participant characteristics including age, sex, and preexisting chronic conditions but not on regional (i.e. state and district-level) differences in Germany.
Authors
- Karin Halina Greiser (ORCID: https://orcid.org/0000-0003-3213-8285)
- Ute Mons (ORCID: https://orcid.org/0000-0003-1764-6783)
- Amand Führer (ORCID: https://orcid.org/0000-0002-8637-5692)
- Ilais Moreno Velásquez (ORCID: https://orcid.org/0000-0001-6058-8983)
- Michael F. Leitzmann (ORCID: https://orcid.org/0000-0002-0371-2789)
- Volker Harth (ORCID: https://orcid.org/0000-0003-4308-223X)
- Muhammad Nasir Khan Khattak (ORCID: https://orcid.org/0000-0002-2286-3451)
- Matthias Bernd Schulze (ORCID: https://orcid.org/0000-0002-0830-5277)
- Hajo Zeeb (ORCID: https://orcid.org/0000-0001-7509-242X)
- Benedikt Lampl (ORCID: https://orcid.org/0000-0002-1008-7934)
- W. Lieb
- Tobias Pischon (ORCID: https://orcid.org/0000-0003-1568-767X)
- Klaus Berger (ORCID: https://orcid.org/0000-0001-8966-3684)
- Nadia Obi (ORCID: https://orcid.org/0000-0002-0903-9142)
- Janka Massag (ORCID: https://orcid.org/0000-0002-0995-0593)
- Thomas Keil (ORCID: https://orcid.org/0000-0002-9108-3360)
- Karina Karolina De Santis (ORCID: https://orcid.org/0000-0001-7647-6767)
- Cara Övermöhle (ORCID: https://orcid.org/0009-0009-2856-2260)
- Theresa Herrmann (ORCID: https://orcid.org/0009-0004-6108-1593)
- Börge Schmidt
- Niels Ole Kristiansen
- Carolina J. Klett-Tammen
- Anette Peters
- Lilian Krist
- André Karch
- Alexandra Nieters
- Laura R. Pfrommer
- Rafael Mikolajczyk
- Kerstin Wirkner
- Hermann Brenner
Institutions
- OTH Regensburg (DE)
- Universität Hamburg (DE)
- University of Potsdam (DE)
- German Cancer Research Center (DE)
- Max Delbrück Center (DE)
- Heidelberg University (DE)
- University of Münster (DE)
- University of Würzburg (DE)
- Universitätsmedizin Greifswald (DE)
- University Medical Center Freiburg (DE)
- Helmholtz Zentrum München (DE)
- Christian-Albrechts-Universität zu Kiel (DE)
- University Medical Center Hamburg-Eppendorf (DE)
- Leibniz Institute for Prevention Research and Epidemiology - BIPS (DE)
- Helmholtz Centre for Infection Research (DE)
- University Hospital in Halle (DE)
- German Institute of Human Nutrition (DE)
- Institute of Molecular Biology (DE)
- University of Regensburg (DE)
- University of Duisburg-Essen (DE)
- Martin Luther University Halle-Wittenberg (DE)
- Charité - Universitätsmedizin Berlin (DE)
- Leipzig University (DE)
Publication Details
- Journal
- BMC Public Health
- Published
- 2026-04-01
- DOI
- https://doi.org/10.1186/s12889-026-27202-w
- Primary Topic
- COVID-19 and healthcare impacts
- Type
- article
- Field-Weighted Citation Impact
- 0.00