RT Journal Article SR Electronic T1 Indirect impact of the COVID-19 pandemic and its containment measures on social inequalities in hospital utilisation in Italy JF Journal of Epidemiology and Community Health JO J Epidemiol Community Health FD BMJ Publishing Group Ltd SP 707 OP 715 DO 10.1136/jech-2021-218452 VO 76 IS 8 A1 Chiara Di Girolamo A1 Roberto Gnavi A1 Tania Landriscina A1 Silvia Forni A1 Manuele Falcone A1 Enrico Calandrini A1 Giulia Cesaroni A1 Antonio Russo A1 Olivia Leoni A1 Caterina Fanizza A1 Alessandra Allotta A1 Giuseppe Costa A1 Teresa Spadea A1 , YR 2022 UL http://jech.bmj.com/content/76/8/707.abstract AB Background The pandemic may undermine the equity of access to and utilisation of health services for conditions other than COVID-19. The objective of the study is to evaluate the indirect impact of COVID-19 and lockdown measures on sociodemographic inequalities in healthcare utilisation in seven Italian areas.Methods In this multicentre retrospective study, we evaluated whether COVID-19 modified the association between educational level or deprivation and indicators of hospital utilisation and quality of care. We also assessed variations in gradients by sex and age class. We estimated age-standardised rates and prevalence and their relative per cent changes comparing pandemic (2020) and pre-pandemic (2018–2019) periods, and the Relative Index of Inequalities (RIIs) fitting multivariable Poisson models with an interaction between socioeconomic position and period.Results Compared with 2018–2019, hospital utilisation and, to a lesser extent, timeliness of procedures indicators fell during the first months of 2020. Larger declines were registered among women, the elderly and the low educated resulting in a shrinkage (or widening if RII <1) of the educational gradients for most of the indicators. Timeliness of procedures indicators did not show any educational gradient neither before nor during the pandemic. Inequalities by deprivation were nuanced and did not substantially change in 2020.Conclusions The socially patterned reduction of hospital utilisation may lead to a potential exacerbation of health inequalities among groups who were already vulnerable before the pandemic. The healthcare service can contribute to contrast health disparities worsened by COVID-19 through more efficient communication and locally appropriate interventions.Data are available upon reasonable request. The health administrative databases which are the data sources of this study are not publicly available; the unidentifiable aggregated data will be available from the corresponding author upon reasonable request.