PROJECT SUMMARY Lack of health system readiness during the Coronavirus 2019 (COVID-19) pandemic has led to widespread disruptions in healthcare utilization. This includes forgone care, which is defined as someone who perceives a need for healthcare but does not receive it. These disruptions have exacerbated the morbidity and mortality associated with the pandemic and have disproportionately impacted those who experience inequities across the social and structural determinants of health (SDoH). This includes social and structural factors at both the individual and community levels, such as income, access to public transportation, and proximity to healthcare services, that may influence healthcare use during the pandemic. Existing literature on the impacts of the pandemic on healthcare utilization predominately describe outpatient and hospital trends. However, very few studies have captured patient-reported forgone care. Those studies that do look at forgone care during the pandemic have evaluated national-level data or used convenience sampling methods, which may limit generalizability to minoritized and economically vulnerable communities. The purpose of this study is to further describe forgone care during the COVID-19 pandemic and its associations with the SDoH among a sample of adults living in Baltimore, Maryland. The applicant will conduct a secondary data analysis using a combined analytic dataset from the Community Collaborative to Combat COVID-19 (C-Forward) and COVID- 19 Prevention Network 5002 (CoVPN) studies. Each of these studies used separate, yet complimentary sampling strategies that will help improve representativeness of the Baltimore population. The C-Forward study uses a population representative sampling strategy, organized by census block groups. The CoVPN study used venue-based sampling, with oversampling of venues located in lower-income and underserved areas of Baltimore. This sub-study will use questions on forgone care completed on enrollment in each parent study. The aims are to: Aim 1: To characterize the prevalence of forgone care in Baltimore during the COVID-19 pandemic by individual-level factors through a cross-sectional analysis of a combined analytic sample of CoVPN and C-Forward participants. Aim 2: To examine the relative importance of individual and community level SDoH with the odds of forgone care. Aim 3: In an exploratory analysis, compare the predictors of forgone emergency care with predictors of forgone chronic and preventive care. Understanding the overall prevalence of forgone care during the COVID-19 pandemic and its intersections with the SDoH is critical to providing a comprehensive view of the health impacts of the pandemic and informing the development of models of care that can be leveraged during COVID-19 and future public health emergencies to maintain individual and community health. The proposed dissertation study and training plan directly align with the NINR’s mission to address health inequities and the SDoH, specifically within the context of public health emergencies.

PROJECT NARRATIVE The Coronavirus 2019 (COVID-19) pandemic has led to widespread disruptions in healthcare utilization in the United States, including increases in forgone care, and has disproportionately impacted those who experience inequities across the social and structural determinants of health (SDoH). The purpose of this study is to further describe forgone care and its associations with the SDoH in Baltimore, MD using a combined analytic sample from two NIH-funded COVID-19 prevalence studies conducted using different recruitment approaches. The knowledge gained from this study will be critical to better understanding which individuals and communities are most at risk for short and long-term health consequences due to forgone care and how to strengthen health systems so that they are better prepared for future public health emergencies.