Missing Medical Appointments Kills Clients: Researchers

“Appointment cancellation rates were 77% higher for people with appointments in the shutdown period,” the researchers write.

Laboratory test rates for patients with post-shutdown appointments were 35% lower.

Overall, a 10% increase in health care appointments reduced mortality rates by about 2.9%, and 10,000 cancellations produced about 30 extra deaths, the researchers say.

That implies about one extra death for every 333 cancellations, the researchers estimate.

Age and Health Status

Older people tend to be much more likely to die than sicker people, and people with health problems tend to be much more likely to die than healthier people.

In 2019, for example, before the COVID-19 pandemic made the headlines, the United States reported about 1 death per year for 1,000 residents ages 15 through 34, and roughly 1 death per year for every 115 residents ages 55 through 64, according to National Center for Health Statistics data.

But the effects of medical appointment cancellations led to big increases in the otherwise low expected death rates for young people and healthy people as well as for other people, the researchers found.

Here are the estimated increases in actual mortality rates, when compared with the expected levels, broken down by age group for patients with missed appointments:

0-17: 15 percentage points higher
18-25: 9.3 percentage points higher
26-35: 8.3 percentage points higher
36-45: 9.6 percentage points higher
46-55: 11 percentage points higher
56-64: 14 percentage points higher
65 and older: 20 percentage points higher

Similarly, cancellations increased 12-month death risk by 9.6 deaths per 10,000 cancellations in the group of patients with no known chronic conditions, 26 extra deaths per 10,000 cancellations for patients with heart disease, and 293 extra deaths per 10,000 cancellations for patients with cancer.

That means cancellations caused one extra death per 1,0142 cancellations for patients who appeared to be health, one extra death per 385 cancellations for patients for patients with heart disease, and one extra death per 34 cancellations for patients with cancer.

The researchers conclude that “cancellation shock” might explain one-quarter to one-third of the excess U.S. deaths from causes other than COVID-19 that occurred between March 2020 and March 2021.

A good focus for future research would be studying the effects of different types of outpatient care, to see which types of care have the most impact on people’s health, the researchers say.

Another Analysis

Gravie, a company in the individual coverage health reimbursement arrangement market, found that 54% of 1,000 consumers polled in August said they had delayed or canceled a medical exam or procedure due to cost, and 59% reported that they had experienced negative consequences from delaying medical exams, treatments or procedures.

The results imply that missed care might be affecting relatively young, healthy, working-age populations as well as older, sicker people.