OBJECTIVES: An estimated 41% of Americans delayed medical care in 2020 due to concerns about COVID-19. This analysis explores the associations between relevant social determinants of health (SDOH) and delayed medical care, almost three years after the pandemic started.

METHODS: 203,486 US adults from an online health community responded to a survey on their social circumstances between May and December 2023. They were asked “Have you delayed getting any medical care in the past year (for example, an annual physical, health screening or necessary test)?”. Individuals were classified as not delaying care or delaying care for either financial reasons or non-financial reasons only. Delayed care was modeled on SDOH using multinomial logistic regression adjusting for age, gender, race, and US region.

RESULTS: Over a third of respondents (37%) delayed medical care. Among those who delayed, the most common reasons were financial, such as high cost (49%) and not affording to take time off work (34%). Non-financial reasons included inability to schedule an appointment (22%) and clinics not being open (18%). Those with financial strain, environmental hazards (e.g., loud noise, air pollution), and difficulty understanding or being understood by a healthcare provider delayed care (odds ratios [ORs] 1.2-3.8). Those unemployed and looking for work, lacking reliable transportation, and enrolled in Medicaid delayed care, notably for non-financial reasons versus financial reasons (ORs 1.2-2.1).

CONCLUSIONS: Our findings suggest that lack of transportation, insurance type, and unemployment negatively impact timely care, even after accounting for financial strain. In addition, individuals who delay care for financial reasons are likely to experience other SDOH challenges that further contribute to poor health outcomes. Addressing barriers to timely care should be tailored to individuals’ SDOH profiles.