Assessing the indirect effects of COVID-19 on healthcare delivery, utilization and health outcomes: a scoping review

Eur J Public Health. 2021 Jul 13;31(3):634-640. doi: 10.1093/eurpub/ckab047.


Background: The COVID-19 pandemic and global efforts to contain its spread, such as stay-at-home orders and transportation shutdowns, have created new barriers to accessing healthcare, resulting in changes in service delivery and utilization globally. The purpose of this study is to provide an overview of the literature published thus far on the indirect health effects of COVID-19 and to explore the data sources and methodologies being used to assess indirect health effects.

Methods: A scoping review of peer-reviewed literature using three search engines was performed.

Results: One hundred and seventy studies were included in the final analysis. Nearly half (46.5%) of included studies focused on cardiovascular health outcomes. The main methodologies used were observational analytic and surveys. Data were drawn from individual health facilities, multicentre networks, regional registries, and national health information systems. Most studies were conducted in high-income countries with only 35.4% of studies representing low- and middle-income countries (LMICs).

Conclusion: Healthcare utilization for non-COVID-19 conditions has decreased almost universally, across both high- and lower-income countries. The pandemic's impact on non-COVID-19 health outcomes, particularly for chronic diseases, may take years to fully manifest and should be a topic of ongoing study. Future research should be tied to system improvement and the promotion of health equity, with researchers identifying potentially actionable findings for national, regional and local health leadership. Public health professionals must also seek to address the disparity in published data from LMICs as compared with high-income countries.

Publication types

  • Review

MeSH terms

  • COVID-19*
  • Delivery of Health Care
  • Developing Countries
  • Humans
  • Pandemics
  • SARS-CoV-2