Disparities in the use of colorectal cancer screening in a universally insured population during the COVID‐19 pandemic
Abstract Background Despite the known efficacy of colorectal cancer (CRC) screening, the rates of individuals undergoing such testing have remained lower than target thresholds, even prior to the healthcare disruptions associated with the COVID‐19 pandemic. We evaluated the impact of the COVID‐19 pa...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-09-01
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| Series: | Cancer Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/cam4.6400 |
| _version_ | 1797672361595502592 |
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| author | Satish Munigala Andrew J. Schoenfeld Vivitha Mani Amanda Banaag Ada Umoh Christian L. Coles Tracey Perez Koehlmoos |
| author_facet | Satish Munigala Andrew J. Schoenfeld Vivitha Mani Amanda Banaag Ada Umoh Christian L. Coles Tracey Perez Koehlmoos |
| author_sort | Satish Munigala |
| collection | DOAJ |
| description | Abstract Background Despite the known efficacy of colorectal cancer (CRC) screening, the rates of individuals undergoing such testing have remained lower than target thresholds, even prior to the healthcare disruptions associated with the COVID‐19 pandemic. We evaluated the impact of the COVID‐19 pandemic on CRC screening within a nationally representative US population and assessed disparities in screening across racial/ethnic groups and socioeconomic (SES) strata. Methods We performed a retrospective cross‐sectional study using all eligible TRICARE beneficiaries aged 45–64 years between FY 2018 and 2021. High‐risk individuals, those with a previous or current CRC diagnosis, and/or a personal/family history of colonic polyps, were excluded. The pre‐COVID‐19 period (September 1, 2018–March 31, 2020) was compared to the COVID‐19 period (April 1, 2020–September 30, 2021). Secondary analyses were performed, evaluating the interaction between the COVID‐19 time period, race, and our proxy for socioeconomic status. Results During the study period, we identified 1,749,688 eligible individuals. Following the onset of the COVID‐19 pandemic, CRC screening overall decreased from 34% in the pre‐pandemic period to 30% following the onset of the pandemic (p < 0.001). This finding persisted even after adjusting for confounders in multivariable analysis (odds ratio [OR] for the pandemic timeframe: 0.79; 95% CI: 0.27, 0.31; p < 0.001). In the setting of SES, in the pandemic period, the odds of individuals from both Senior Enlisted (OR: 0.55; 95% CI: 0.54, 0.56) and Junior Enlisted sponsor ranks (OR: 0.27; 95% CI: 0.25, 0.30) were diminished as compared to Senior Officers. Conclusions and Relevance We found a 21% reduction in the odds of CRC screening in the context of the COVID‐19 pandemic. Reductions in colonoscopies and other types of screening tests were not offset by changes in the use of at‐home tests such as Cologuard. |
| first_indexed | 2024-03-11T21:28:56Z |
| format | Article |
| id | doaj.art-7ccd989ae02c43c0b67df437b8162d30 |
| institution | Directory Open Access Journal |
| issn | 2045-7634 |
| language | English |
| last_indexed | 2024-03-11T21:28:56Z |
| publishDate | 2023-09-01 |
| publisher | Wiley |
| record_format | Article |
| series | Cancer Medicine |
| spelling | doaj.art-7ccd989ae02c43c0b67df437b8162d302023-09-27T11:46:08ZengWileyCancer Medicine2045-76342023-09-011217182011821010.1002/cam4.6400Disparities in the use of colorectal cancer screening in a universally insured population during the COVID‐19 pandemicSatish Munigala0Andrew J. Schoenfeld1Vivitha Mani2Amanda Banaag3Ada Umoh4Christian L. Coles5Tracey Perez Koehlmoos6Center for Health Services Research Uniformed Services University of the Health Sciences Bethesda Maryland USADepartment of Orthopaedic Surgery and Center for Surgery and Public Health Brigham and Women's Hospital, Harvard Medical School Boston Massachusetts USACenter for Health Services Research Uniformed Services University of the Health Sciences Bethesda Maryland USACenter for Health Services Research Uniformed Services University of the Health Sciences Bethesda Maryland USACenter for Health Services Research Uniformed Services University of the Health Sciences Bethesda Maryland USACenter for Health Services Research Uniformed Services University of the Health Sciences Bethesda Maryland USACenter for Health Services Research Uniformed Services University of the Health Sciences Bethesda Maryland USAAbstract Background Despite the known efficacy of colorectal cancer (CRC) screening, the rates of individuals undergoing such testing have remained lower than target thresholds, even prior to the healthcare disruptions associated with the COVID‐19 pandemic. We evaluated the impact of the COVID‐19 pandemic on CRC screening within a nationally representative US population and assessed disparities in screening across racial/ethnic groups and socioeconomic (SES) strata. Methods We performed a retrospective cross‐sectional study using all eligible TRICARE beneficiaries aged 45–64 years between FY 2018 and 2021. High‐risk individuals, those with a previous or current CRC diagnosis, and/or a personal/family history of colonic polyps, were excluded. The pre‐COVID‐19 period (September 1, 2018–March 31, 2020) was compared to the COVID‐19 period (April 1, 2020–September 30, 2021). Secondary analyses were performed, evaluating the interaction between the COVID‐19 time period, race, and our proxy for socioeconomic status. Results During the study period, we identified 1,749,688 eligible individuals. Following the onset of the COVID‐19 pandemic, CRC screening overall decreased from 34% in the pre‐pandemic period to 30% following the onset of the pandemic (p < 0.001). This finding persisted even after adjusting for confounders in multivariable analysis (odds ratio [OR] for the pandemic timeframe: 0.79; 95% CI: 0.27, 0.31; p < 0.001). In the setting of SES, in the pandemic period, the odds of individuals from both Senior Enlisted (OR: 0.55; 95% CI: 0.54, 0.56) and Junior Enlisted sponsor ranks (OR: 0.27; 95% CI: 0.25, 0.30) were diminished as compared to Senior Officers. Conclusions and Relevance We found a 21% reduction in the odds of CRC screening in the context of the COVID‐19 pandemic. Reductions in colonoscopies and other types of screening tests were not offset by changes in the use of at‐home tests such as Cologuard.https://doi.org/10.1002/cam4.6400cancer preventioncolorectal cancerepidemiology and preventionscreening |
| spellingShingle | Satish Munigala Andrew J. Schoenfeld Vivitha Mani Amanda Banaag Ada Umoh Christian L. Coles Tracey Perez Koehlmoos Disparities in the use of colorectal cancer screening in a universally insured population during the COVID‐19 pandemic Cancer Medicine cancer prevention colorectal cancer epidemiology and prevention screening |
| title | Disparities in the use of colorectal cancer screening in a universally insured population during the COVID‐19 pandemic |
| title_full | Disparities in the use of colorectal cancer screening in a universally insured population during the COVID‐19 pandemic |
| title_fullStr | Disparities in the use of colorectal cancer screening in a universally insured population during the COVID‐19 pandemic |
| title_full_unstemmed | Disparities in the use of colorectal cancer screening in a universally insured population during the COVID‐19 pandemic |
| title_short | Disparities in the use of colorectal cancer screening in a universally insured population during the COVID‐19 pandemic |
| title_sort | disparities in the use of colorectal cancer screening in a universally insured population during the covid 19 pandemic |
| topic | cancer prevention colorectal cancer epidemiology and prevention screening |
| url | https://doi.org/10.1002/cam4.6400 |
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