Objective: Historically marginalized groups have higher rates of poor glycemic control linked to barriers in access to care. We sought to examine whether there was a differential effect of the COVID-pandemic on loss-to-follow-up (LTFU) rates among high-risk youth with T1D based on language for care, race, and ethnicity.
Methods: Retrospective cohort study of pediatric patients with T1D (HbA1c ≥9%) seen at a tertiary care diabetes clinic between 1/1/18-2/29/20 (pre-COVID period) and 3/1/20-1/31/21 (COVID period) . LTFU was tracked monthly and defined as patients not seen in the preceding 6 months. Preferred language for care, race, and ethnicity data were obtained from visit registration data. Generalized estimating equations were used to examine associations between time-periods (pre-COVID versus COVID) and LTFU rates, adjusted for patient age. In two models, separate interaction terms for (1) language for care and (2) race and ethnicity were introduced to assess for effect modification.
Results: 1359 patients were included (9.5% with language other than English [LOE]; 33.5% from historically marginalized racial and ethnic groups) . We found a 1.27 higher odds (95% CI: 1.08, 1.49) of LTFU after the onset of the pandemic, with differential effects based on language for care. Among patients with LOE, the odds of LTFU in the COVID period was 4.14 higher (95% CI: 2.35, 7.29) compared to the pre-COVID period. LTFU rates did not significantly differ between time periods among English-speaking patients (OR 1.12 [95% CI: 0.95, 1.33]) . Patient’s race and ethnicity did not modify the effect of the COVID-pandemic on LTFU rates.
Conclusion: The COVID-pandemic has exacerbated LTFU rates in high-risk youth with T1D and disproportionately impacted patients whose preferred language for care is a LOE. Interventions to improve LTFU rates should include targeted efforts to reduce health disparities in access to care in this high-risk population.
M.Gupta: None. K.Carlin: None. A.J.Roberts: None. F.Malik: n/a. A.Desai: None.