Indirect effects of the COVID-19 pandemic on healthcare contacts, quality of care, and social disparities across essential healthcare domains

Background: The COVID-19 pandemic significantly affected global healthcare systems, revealing their resilience to crises. Despite this, national-level research on its impact across key healthcare domains - such as acute and chronic disease management, cancer screening and care, mental health, and palliative care - is scarce. This study examines the pandemic's impact on contacts, quality of care, and social disparity in these healthcare domains to guide better preparedness for future health emergencies. Methods: The study utilized data from the Danish National Clinical Quality Registries, covering January 2015 to June 2022, to create a nationwide cohort for comparing healthcare metrics across the pandemic's phases and the prepandemic period. Healthcare contacts were assessed through descriptive analyses, while the quality of care and social disparities were analysed using multivariable regression models, providing estimated prevalence ratios and 95% confidence intervals. Results: The first wave of the COVID-19 pandemic in Denmark led to community and healthcare lockdowns, which were associated with fewer hospital contacts and reduced participation in national cancer screening programs. However, a gradual recovery towards prepandemic levels was found, with the exceptions of chronic obstructive pulmonary disease contacts and colorectal cancer incidence. Overall, the quality of care across various healthcare domains in Denmark remained largely unchanged or improved slightly during the pandemic. However, social disparities in contacts were increased across all examined healthcare domains, with patients who were immigrants, living alone, had limited educational level or low income experiencing reduced contact compared to the prepandemic period. Conclusions: Overall, the Danish healthcare system appeared to be resilient and largely unaffected throughout the pandemic, and the quality of care in several healthcare domains remained high. Nevertheless, the increasing social disparities in healthcare contacts during the pandemic demands attention. In preparing for future health crises, it is important to address and mitigate potential social inequalities, focusing on achieving equity in healthcare.