Racial and Ethnic Disparities in Attendance to Well-Child Visit Recommendations during COVID-19

OBJECTIVE: To measure the impact of the COVID-19 pandemic on racial and ethnic disparities in attendance to wellchild visit recommendations. METHODS: We used the nationally representative Medical (2018-2019) and pandemic (2020 and 2021) ratios of wellchild visits to age-based recommendations, presenting both unadjusted and adjusted attendance disparities over time. We also used the 1996-2021 MEPS to place the pandemic changes in an historical context. RESULTS: Average attendance decreased from 66.6% in 2018-2019 (95% confidence interval [CI]: 64.1, 69.1) to 58.6% in 2020 (95% CI: 55.5, 61.6), rebounding to 65.1% in 2021 (95% CI: 61.5, 68.7). The unadjusted disparity in attendance between White non-Hispanic and Black non-Hispanic children widened from 9.6 percentage points in 2018-2019 (95% CI: 2.8, 16.4) to 24.8 percentage points in 2020 (95% CI: 17.5, 32.2) and 21.4 percentage points in 2021 (95% CI: 11.2, 31.5). The unadjusted disparity in attendance between White non-Hispanic and Hispanic children widened from 14.8 percentage points in 2018-2019 (95% CI: 9.7, 19.8) to 26.3 percentage points in 2020 (95% CI: 19.9, 32.7) and 24.9 percentage points in 2021 (95% CI: 17.5, 32.3). Changes in disparities were large even when we controlled for health status, demographic and socioeconomic characteristics, health insurance, and state of residence. Magnitudes of the racial and ethnic attendance disparities during the pandemic's first two years were unCONCLUSIONS: Widening attendance disparities during the pandemic highlight the need to build a more equitable