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Introduction: Healthcare has been disrupted during the COVID-19 pandemic due to overburdened healthcare services and a decline in utilization due to people avoiding the care settings. Avoiding healthcare could affect peoples’ health, and there are possibly many individual and contextual factors involved in that outcome. Little is known about what determinants influence the decision in the Swedish context. This study therefore aims to assess the individual and municipality level factors associated with avoiding healthcare during the COVID-19 pandemic among the Swedish population.

Method: This study had a cross-sectional design and used data from the Health on Equal Terms (HET) survey issued in Sweden 2021, complemented by demographic data from the official population registry. The individual data was collected by Statistics Sweden (SCB) by random sampling in the population registry and consisted of 17076 participants between the ages of 18- to 84-year-old. The variables representing the municipality level were created from population registry public statistics. Analysis was done by multilevel logistic regression that accounted for individual and municipality factors.

Result: About 33% of the total sample had avoided healthcare, with women being more likely (OR 1.29, CI 1.21-1.38) to have avoided care compared to men. People belonging to a risk group had 1.32 times higher odds (CI 1.23-1.42) of avoiding care. People born within Europe and North America were more likely (OR 1.3 CI 1.12-1.5) than Swedish born to have avoided care, as were people born outside of that area (OR 1.48, CI 1.29-1.71). Belonging to the lowest income group meant having higher odds of avoiding healthcare (OR 1.22, CI 1.08-1.38) than the highest income group. People with low or medium education were less likely (OR 0.75, CI 0.67-0.85 and OR 0.91, CI 0.85-0.99 respectively) of avoiding healthcare than the highly educated. The general municipality variance in avoiding healthcare was small, with 1,3% of the variance attributed to the municipality differences.

Conclusion: The results presented that women, migrants born outside the Nordic countries, people belonging to risk groups, and those having the lowest income were more likely to avoid care and this needs to be consideration in future policies aimed at maintaining healthcare utilization during a pandemic.