Preventive Care Disruptions and Emergency Hospitalizations: Evidence from COVID-19 and SHARE

TL;DR

This study finds that disruptions to preventive mammography during COVID-19's first wave increased emergency hospitalizations among women aged 50-69, highlighting the importance of continuous preventive care.

Contribution

It provides causal evidence that preventive care disruptions during a pandemic can lead to increased emergency hospitalizations in targeted populations.

Findings

Mammography reduces emergency hospitalizations by about 6 percentage points.

No significant effect observed among women aged 70 and above.

Results are robust across various controls and falsification tests.

Abstract

We study whether disruptions to preventive care during the first wave of the coronavirus disease 2019 pandemic affected subsequent acute hospital use. Using the Survey of Health, Ageing and Retirement in Europe from eight countries, we focus on women aged 50-69, the target group for organized breast cancer screening. The outcome is an indicator for any all-cause emergency overnight hospitalization in the prior twelve months. To address selection into screening, we use an instrumental variables design based on six interview-month cohorts in Wave 9 (March-August 2022) interacted with country indicators. Because mammography is reported over a two-year recall window anchored to the interview month, these cohort-by-country interactions shift how much of the March-August 2020 restriction period falls inside the recall window, generating variation in mammography uptake across cohorts within countries. The estimates imply that mammography reduces emergency overnight hospitalization by about six percentage points. No effect appears among women aged 70 and above. Results are robust to controls, disruption measures, and falsification tests.