Biologic sex inequality in rheumatology wait times during the COVID-19 pandemic.

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

METHODS: De-identified data of all referred patients between November 2019 and June 2022 were extracted from the electronic medical record. Variables including time from referral to first appointment, biologic sex, referral period, urgency status, age, and geographic location were collected and analyzed.

RESULTS: 12,817 referrals were identified. Wait-times increased by 24.3 days in the peri-COVID time period (p<0.001). In the pre-COVID time period, there was no significant difference in wait-times by biologic sex or age. Triage urgency was a predictor of wait time with semi-urgent referrals seen 8.94 days (95% CI -15.90 to -1.99) sooner than routine referrals and urgent referrals seen 25.42 days (95% CI -50.36 to -0.47) sooner than routine referrals. In the peri-COVID time period, there was a significant difference in wait time by biologic sex with women waiting on average 10.03 days (95% CI 6.98 to 13.09) longer than men (p<0.001). Older patients had shorter wait times than younger patients, with a difference of -4.64 days for every 10- year increase in age (95% CI -5.5, to-3.8). Triage urgency continued to be a predictor of wait time.

CONCLUSION: Women and younger patients appear to have been impacted by wait time increases during the COVID-19 pandemic. This finding should be further investigated to determine its pervasiveness across other specialties and to better understand the underlying cause of this finding.