health service utilization in hong kong during the covid-19 pandemic – a cross-sectional public survey

Background: as health systems across the world respond to the coronavirus disease 2019 (covid-19), there is rising concern that patients without covid-19 are not receiving timely emergency care, resulting in avoidable deaths. this study examined patterns of self-reported health service utilization, their socio-demographic determinants and association with avoidable deaths during the covid-19 outbreak. methods: a cross-sectional telephone survey was conducted between march 22 and april 1, 2020, during the peak rise in confirmed covid-19 cases in hong kong. cantonese-speaking hong kong residents over 18-years-old were recruited using a computerised random digital dialling (rdd) system. the rdd method used stratified random sampling to ensure a representative sample of the target population by age, gender, and residential district. a structured self-reported questionnaire was used. results: out of 1738 placed calls, 765 subjects responded to the questionnaire (44.0% response rate). the factors associated with avoiding medical consultation included being female (37.2% vs. 22.5%, p < .001), married (32.8% vs. 27%, p = .044), completing tertiary education (35.3% vs. 27.7% (secondary) vs. 14.8% (primary), p = .005), and those who reported a “large/very large” impact of covid-19 on their mental health (36.1% vs 30.5% (neutral) vs. 19.7% (very small/small), p = .047) using logistic regression analysis. conclusion: married females with both higher educational attainment and concern about covid-19 were associated with avoiding healthcare services. timely public communication to encourage and promote early health seeking treatment even during extreme events such as pandemics are needed.