# Association between Medical Avoidance Behavior and Lifestyle Changes during the Early Phase of Coronavirus Disease 2019 Emergency in Tokyo: A Cross-Sectional Study in a Gastric Cancer Screening Cohort

## TL;DR

This study found that during the early phase of the COVID-19 pandemic in Tokyo, many people avoided medical visits to reduce infection risk, especially women and those with increased family responsibilities.

## Contribution

The study provides new insights into medical avoidance behavior and lifestyle changes among middle-aged and elderly individuals during the initial phase of the pandemic.

## Key findings

- 20.4% of women and 12.7% of men avoided follow-up visits during the emergency due to contact avoidance.
- Women who increased housework or experienced stress were more likely to delay medical care.
- Some individuals continued avoiding healthcare even after the pandemic subsided.

## Abstract

This study examines patient behavior in Tokyo, Japan, during the early phase of the coronavirus disease 2019 (COVID-19) pandemic.

As part of a prospective cohort study on gastric cancer screening participants, we conducted a cross-sectional survey from April 2021 to March 2022. The survey included 1,554 participants (40.5% men, median age: 62, age range: 32-92). Specifically, we investigated whether participants continued hospital follow-up visits and underwent medical checkups and disease prevention screenings during the initial state of emergency in Japan (April to May 2020). We also explored changes in daily life and the psychological effects of COVID-19.

During the state of emergency, 12.7% of men and 20.4% of women discontinued follow-up visits, with the primary reason being a desire to avoid human contact. Additionally, 6.5% of men and 14.2% of women ceased medical checkups and screenings. Among women, those who reported increased time spent on housework and family care, or experienced heightened stress and conflicts with housemates, were significantly more likely to discontinue or delay follow-up visits or treatment (odds ratio [OR] 1.55 [1.08-2.23], OR 1.53 [1.06-2.21]).

Our findings indicate that some middle-aged and elderly Japanese residents in urban areas avoided healthcare services to reduce the risk of COVID-19 infection. A subset of individuals continued this behavior even after the pandemic subsided. It is crucial to prioritize regular checkups for managing chronic illnesses and preventing new conditions. Effective communication strategies should be developed in collaboration with national and local governments.