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Challenges Accessing Food, Water, Healthcare Services, and Medications During the COVID-19 Pandemic Among Adults in Puerto Rico and Their Association with Self-Rated Health: Assessments of PR-CEAL

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Journal of Racial and Ethnic Health Disparities Aims and scope Submit manuscript

Abstract

Background

The COVID-19 pandemic created challenges in accessing food, water, medications, and healthcare services some of which are linked with lower self-rated health (SRH). These challenges have already been documented in the US, but it remains unknown how the pandemic affected access to food, water, medications and healthcare services, and how these challenges relate to SRH in this group, a population experiencing profound health disparities and limited resources prior to the pandemic.

Objective

To assess associations between challenges accessing food, water, healthcare, and medications during the COVID-19 pandemic and SRH among adults in Puerto Rico.

Methods

Cross-sectional analysis of Puerto Rico-CEAL. Adults (>18 years; n=582) completed an online survey (December 30, 2021-February 8, 2022). Presence of each challenge during the past 30 days was measured and analyzed individually and combined (0, 1, >2). SRH (rated from poor-excellent) was measured before and at pandemic. Change in SRH was calculated. Adjusted Poisson models with robust variance errors estimated prevalence ratios (PR).

Results

Experiencing food, water, medication, and healthcare challenges (vs. not) were associated with pandemic fair-poor SRH (PR=1.44, 95%CI=1.06-1.97; PR=1.59, 95%CI=1.15-2.18; PR=1.38, 95%CI=1.05-1.81; and PR=1.56,9 5%CI=1.15-2.12, respectively). Experiencing 2+ challenges (vs. none) was associated with pandemic fair-poor SRH (PR=1.77, 95%CI=1.22-2.55). Additionally, experiencing food, medication, and healthcare challenges (vs. not) was associated with decreased SRH (PR=1.35, 95%CI=1.08-1.69; PR=1.24, 95%CI=1.01-1.51; and PR=1.25, 95%CI=1.01-1.54, respectively), as well as experiencing 2+ challenges (vs. none; PR =1.49, 95%CI=1.15-1.92).

Conclusion

Challenges accessing food, water, medications, and healthcare services during the pandemic were associated with fair-poor SRH and decreased SRH in Puerto Rico. Public health policy should ensure access to basic needs.

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Data Availability

Data will be made available upon request.

Code Availability

Code will be made available upon request.

Funding

This NIH Community Engagement Alliance (CEAL) Against COVID-19 Disparities publication was supported by the National Institutes of Health under Award Number OT2HL161827. Further support from La Alianza, funded by the NIH-NIGMS under Award Number U54GM133807 was obtained. The project was also supported by the NIH NIDDK STEP-UP program under grant number R25DK078381. Dr. López-Cepero is funded by the Building Interdisciplinary Research Careers in Women’s Health of the National Institutes of Health under Award Number K12HD085850.

Author information

Authors and Affiliations

  1. Department of BioSciences, Rice University, Houston, TX, USA

    Nayeli Shad

  2. University of Puerto Rico Comprehensive Cancer Center, San Juan, PR, USA

    Vivian Colón-López

  3. Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico, San Juan, PR, USA

    Cynthia M. Pérez

  4. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA

    Andrea López-Cepero

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  1. Nayeli Shad
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  4. Andrea López-Cepero
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Contributions

All authors have contributed to the scientific aspects of this manuscript. NS: conducted literature review, helped with the conceptual model, analyzed and interpreted the data and drafted the manuscript. CP and VC: acquired the data and revised the manuscript critically for important intellectual content. ALC: designed statistical analysis and conceptual model, supervised data analysis and interpretation and manuscript writing, and helped acquire the data. All authors approved the final version of the manuscript.

Corresponding author

Correspondence to Andrea López-Cepero.

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The Institutional Review Board of the University of Puerto Rico-Medical Sciences Campus approved the parent study.

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Shad, N., Colón-López, V., Pérez, C.M. et al. Challenges Accessing Food, Water, Healthcare Services, and Medications During the COVID-19 Pandemic Among Adults in Puerto Rico and Their Association with Self-Rated Health: Assessments of PR-CEAL. J. Racial and Ethnic Health Disparities 11, 2166–2173 (2024). https://doi.org/10.1007/s40615-023-01685-4

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