ABSTRACT
INTRODUCTION: Colorectal cancer (CRC) screening has reduced CRC mortality. The COVID-19 pandemic led to a reduction in screening volume. We sought to evaluate whether specific populations or socioeconomic groups were disproportionately impacted by the reduced access to care. METHOD(S): Patients eligible for CRC screening in a large integrated healthcare system, who had a primary care visit between January 2016 and April 2022, were evaluated. Trends in CRC screening were assessed by age, race, gender, insurance type, and geographic delineation by state and classification of urban or rural areas. Multilevel logistic regression models evaluated region-level cluster effects of CRC screening by patient demographics, insurance, and social vulnerability index (SVI), including socioeconomic status, household composition and disability, minority status and language, and housing and transportation domains. The interaction between trend in CRC screening and race was also investigated. RESULT(S): A total of 654,386 patients were screeneligible between January 2016 and April 2022. The cohort screening rate peaked at 70% in 2019 with a subsequent downtrend to a nadir of 63.6% through the first part of 2022. Whereas the Native American population is consistently the least screened population, the Asian population demonstrated the most significant decrease in screening during and after the COVID-19 pandemic, falling from a peak at 69.1% in 2019 to 59.3% in 2021;this remains low in 2022 at 58.9%. Further, older patients, males, location in an urban area, White ethnicity and use of commercial insurance were significantly associated with higher odds of CRC screening (p< 0.001). Conversely, patients living in more vulnerable census tracts based on the SVI socioeconomic status and housing/transportation domain had lower odds of having CRC screening (p< 0.001). Finally, there was a significant interaction between trend in CRC screening and race. The CRC screening rate increased between 2016 and 2019 and then decreased for all races, but Asian patients had the most significant decrease in CRC screening between 2020 and 2021 (68.3% versus 60.2%, p< 0.001;Figure 1). CONCLUSION(S): This is the first study to demonstrate that the COVID-19 pandemic led to a population-wide decrease in CRC screening volume that disproportionately affected the Asian population and those of lower socioeconomic status. We are currently evaluating whether this impacted stage migration and mortality. (Figure Presented).