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The effects of India's COVID-19 lockdown on critical non-COVID health care and outcomes: Evidence from dialysis patients

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  • Jain, Radhika
  • Dupas, Pascaline

Abstract

India's COVID-19 lockdown, one of the most severe in the world, is widely believed to have disrupted critical non-COVID health services. However, linking these disruptions to effects on health outcomes has been difficult due to the lack of reliable, up-to-date health outcomes data. We identified all dialysis patients under a statewide health insurance program in Rajasthan, India (N = 2110), and conducted surveys to examine the effects of the lockdown on non-COVID care access and health outcomes. Post-lockdown mortality was our primary outcome and morbidity and hospitalization were secondary outcomes. 63% of patients experienced a disruption to their care. Transport barriers, hospital service disruptions, and difficulty obtaining medicines were the most common causes. We compared monthly mortality in the four months after the lockdown with pre-lockdown mortality trends, as well as with mortality trends for a similar cohort in the previous year. Mortality in May 2020, after a month of exposure to the lockdown, was 1.70 percentage points (95% CI 0.01–0.03) or 64% higher than in March 2020 and total excess mortality between April and July was estimated to be 22%. A 1SD increase in an index of care disruptions was associated with a 0.17SD (95% CI 0.13–0.22) increase in a morbidity index, a 3.1 percentage point (95% CI 0.012–0.051) increase in hospitalization, and a 2.1 percentage point (95% CI 0.00–0.04) increase in probability of death between May and July. Females, socioeconomically disadvantaged groups, and patients living far from the health system faced worse outcomes. The results highlight the unintended consequences of the lockdown on critical, life-saving non-COVID health services that must be taken into account in the implementation of future policy efforts to control the spread of pandemics.

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  • Jain, Radhika & Dupas, Pascaline, 2022. "The effects of India's COVID-19 lockdown on critical non-COVID health care and outcomes: Evidence from dialysis patients," Social Science & Medicine, Elsevier, vol. 296(C).
    • Handle: RePEc:eee:socmed:v:296:y:2022:i:c:s027795362200065x
    DOI: 10.1016/j.socscimed.2022.114762
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    1. Seth Flaxman & Swapnil Mishra & Axel Gandy & H. Juliette T. Unwin & Thomas A. Mellan & Helen Coupland & Charles Whittaker & Harrison Zhu & Tresnia Berah & Jeffrey W. Eaton & Mélodie Monod & Azra C. Gh, 2020. "Estimating the effects of non-pharmaceutical interventions on COVID-19 in Europe," Nature, Nature, vol. 584(7820), pages 257-261, August.
    2. Nina Haug & Lukas Geyrhofer & Alessandro Londei & Elma Dervic & Amélie Desvars-Larrive & Vittorio Loreto & Beate Pinior & Stefan Thurner & Peter Klimek, 2020. "Ranking the effectiveness of worldwide COVID-19 government interventions," Nature Human Behaviour, Nature, vol. 4(12), pages 1303-1312, December.
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    1. Abu S. Shonchoy & Shatakshee Dhongde & Erdal Asker, 2023. "COVID-19 Lockdown and Neonatal Mortality: Evidence from India," Working Papers 2303, Florida International University, Department of Economics.
    2. Cai, Weicheng & Zhou, Yi, 2022. "Men smoke less under the COVID-19 closure policies: The role of altruism," Social Science & Medicine, Elsevier, vol. 306(C).
    3. Warren S. Vaz, 2022. "COVID-19 Impact on the Energy Sector in the United States (2020)," Energies, MDPI, vol. 15(21), pages 1-23, October.

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