How did Californians’ health fare in 2020?
Dr. Ninez Ponce shows how the COVID-19 pandemic, racial tensions, and other challenges impacted health care access and status.
Nationwide, various reports on COVID-19 cases and deaths, racial injustice, and a presidential election flooded the media circuit throughout 2020. As the U.S. continues to grapple with the pandemic’s toll on countless lives, findings from the California Health Interview Survey, or CHIS, are taking a closer look at statewide impacts among 39.5 million Californians.
The just-released data from the survey, from a team at the UCLA Center for Health Policy Research led by Dr. Ninez Ponce, UCLA Fielding School of Public Health professor of health policy and management, shows a range of results on how the pandemic, along with other unprecedented factors, may have affected residents’ health. The research team quickly adapted the survey to add a series of COVID-19 questions last year. A total of 22,661 households were included in the 2020 data, including 21,949 adults, 1,365 adolescents, and 3,548 children.
For example, the survey found that COVID-19 was a primary reason why people delayed or decided to go without medical care in 2020. In contrast, it may have been a surprise that there were a record number of Californians — 94% — who had health insurance coverage last year. Differences in health care access, especially across racial and ethnic groups, were more likely to have been magnified during this time period. This was confirmed by an accompanying policy brief, which estimated that about 1 in 10 or 11% of Black and African American respondents said that they did not have a usual place to go when sick or needing health advice in 2020, a 26% jump from 2019, despite almost 90% of this group being insured.
Data on pandemic impacts, health status and behaviors along with other health-related topics are part of the center’s annual CHIS data release, which takes place online today at noon PT.
“This is one of the most important data releases in the survey’s 20-year history because it sheds light on how impactful the pandemic was on multiyear trends in California for health-related behaviors and access to health care, as well as unfair treatment due to race or ethnicity” said Todd Hughes, CHIS director. “These findings are building on the CHIS preliminary COVID-19 monthly estimates we released starting in September 2020, more than a year in advance of this year’s full release, that provided early monthly data on COVID-19 treatment and vaccine acceptability, as well as personal and financial impacts of the pandemic to aid in the state’s response to the ongoing crisis.”
Among the 2020 survey results:
COVID-19 was cited as a primary reason why Californians delayed or decided to go without medical care in 2020. More than 1 in 5 or 21.6% of all Californians who reported delaying or forgoing medical care cited COVID-19 as the main reason. Older adults ages 65 and up were more likely among all age groups to cite COVID-19 as the main reason for delaying or forgoing care at 44.2%.
Reports of unfair treatment based on race and ethnicity were more pronounced among certain groups. Black and Asian adults were more likely to report experiencing unfair treatment compared to all racial and ethnic groups at 6.4% and 4.2%, respectively. Black adults were more than three times as likely and Asian adults more than twice as likely to report unfair treatment compared to all California adults at 1.9%. Adults who reported being treated unfairly due to race and ethnicity were also more likely to say they had thoughts of suicide compared to individuals who said they did not experience unfair treatment due to race — 19.3% vs. 12.1%.
Essential workers reported at higher rates that they ever had or thought they had COVID-19, but were less likely to say in 2020 that they would get the vaccine compared to nonessential workers. 15.1% of essential workers ever had or thought they had COVID-19 compared to 12.1% of nonessential workers. 73.6% of essential workers said they would get the COVID-19 vaccine compared to 76.7% of nonessential workers.
Stay-at-home orders in 2020 led to improvements for youth in eating a healthy diet and avoiding binge drinking, but led to worsening in other behaviors like sedentary activities and nearly constant internet usage. In 2020, 2.6% of adolescents ages 12 to 17 said they engaged in binge drinking in the past month compared to 7% in 2019. The percentage of adolescents who said they ate five or more servings of fruits and vegetables daily was 26.1% in 2019 and 33.3% in 2020. There was a 51% increase from 2019 to 2020 of adolescents reporting that they were “almost constantly” on the internet — 28.6% in 2019 vs. 43.2% in 2020. The percentage of children and adolescents ages 2 to 17 who spent 5 or more hours on sedentary activities increased from 2019 to 2020 — 35.4% in 2019 vs. 40.8% in 2020.
“Seeing how COVID-19 affected the physical, mental and emotional health of Californians benefits not only researchers, but individuals and groups engaged in policy and on-the-ground efforts across the state,” said Ponce, who is also CHIS principal investigator. “Because the targeted data can be acted on, it enables those in power to determine which Californians most need help.”
The new survey results are available to the public for free through the center’s AskCHIS™ website. In addition, public use files with the new data are downloadable from the website, and researchers may access confidential data files from the study by applying to the center’s Data Access Center.
The California Health Interview Survey, the nation’s largest state health survey, covers numerous categories, including general health status, health conditions, neighborhood and housing, health insurance, child care, employment, income, and other measures, such as race and ethnicity, marital status, sexual orientation, and citizenship.
by Elaiza Torralba
The UCLA Fielding School of Public Health, founded in 1961, is dedicated to enhancing the public's health by conducting innovative research, training future leaders and health professionals from diverse backgrounds, translating research into policy and practice, and serving our local communities and the communities of the nation and the world. The school has 631 students from 26 nations engaged in carrying out the vision of building healthy futures in greater Los Angeles, California, the nation and the world.
Faculty Referenced by this Article
EMPH Academic Program Director with expertise in healthcare marketing, finance, and reproductive health policy, teaching in the EMPH, MPH, MHA program
Dr. Ron Andersen is the Wasserman Professor Emeritus in the UCLA Departments of Health Policy and Management.
Nationally recognized health services researcher and sociomedical scientist with 25+ years' experience in effectiveness and implementation research.
Dr. Michelle S. Keller is a health services researcher whose research focuses on the use and prescribing of high-risk medications.
Professor of Community Health Sciences & Health Policy and Management, and Associate Dean for Research
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