Disparities in the use of colorectal cancer screening in a universally insured population during the COVID-19 pandemic

Satish Munigala; Andrew J Schoenfeld; Vivitha Mani; Amanda Banaag; Ada Umoh; Christian L Coles; Tracey Perez Koehlmoos

doi:10.1002/cam4.6400

Disparities in the use of colorectal cancer screening in a universally insured population during the COVID-19 pandemic

Cancer Med. 2023 Sep;12(17):18201-18210. doi: 10.1002/cam4.6400. Epub 2023 Aug 29.

Authors

Satish Munigala^{1

2}, Andrew J Schoenfeld³, Vivitha Mani^{1

2}, Amanda Banaag^{1

2}, Ada Umoh^{1

2}, Christian L Coles^{1

2}, Tracey Perez Koehlmoos¹

Affiliations

¹ Center for Health Services Research, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
² The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA.
³ Department of Orthopaedic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.

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.

Keywords: cancer prevention; colorectal cancer; epidemiology and prevention; screening.

Grants and funding

HU0012120089/Department of Defense, Defense Health Agency