Persistent Inequality in Access to Rheumatology Care for Females After the COVID-19 Pandemic

Objective: To examine the effect of biological sex on wait-times to first rheumatology appointment in a central triage system before, during and after the COVID-19 pandemic.

Methods: De-identified data of patients referred to one centralised Rheumatology referral centre between November 2019 and December 2023 were extracted from the electronic medical record. Variables collected and analysed included time from referral to first appointment, biological sex, referral period, triage urgency, age, and geographic location.

Results: 19,681 referrals were identified. In the pre-COVID period, there was no significant difference in wait-times by biological sex or age. After adjusting for triage level, age and geographic location, females waited significantly longer in the peri-COVID period versus males (10.2 days, 95% CI 7.1, 13.3), which persisted in the post-COVID period (7.5 days, 95% CI 4.0, 11.1). Similarly, younger patients waited longer than older patients in the peri-COVID period (4.7 fewer days per decade increase in age (95% 3.9, 5.6)). This age discrepancy persisted through the post-COVID period (2.3 days, 95% CI 1.6, 3.5). Geographic location was a significant predictor of wait-times in the post-COVID period, with those outside of Edmonton waiting longer than in Edmonton. Once the change in referral pattern from Northwest Territories was accounted for, this discrepancy ceased.

Conclusions: Female and younger patients have been disproportionately impacted by wait-time increases during the COVID-19 pandemic, with minimal improvements observed during the post-COVID period. These findings should prompt further investigation into the underlying causes of these observed inequities in access to rheumatology care to identify solutions.