ABSTRACT
To determine the racial disparities in oncology visits of racial minorities before and after COVID-19. Data were obtained from the electronic health records, a multi-specialty healthcare system serving a racially/ethnically diverse patient population in northern California. The study cohort included patients who had at least one oncology visit from January 2019 to August 2020. We examined the trends in the volume of oncology office visits and adoption of video visits during the ongoing COVID-19 pandemic period. Chi-square test and multivariate logistic regression were performed to examine variability in use of video visits by specific patient characteristics (sex, age, race/ethnicity and language barrier). Of 63,903 cancer patients (median age: 66;68% female), Whites, Blacks, Hispanics, Asians and others composed of 64.8%, 3.5%, 9.2%, 11.7% and 10.8% of our study cohort. Over the 20 month study period, the drop in in-person visits began in March and peaked in April 2020. Compared to the year 2019, the office visits decreased by -16.6%, -55.9%, and -50.9% in March, April, and May of 2020. Although there was a trend towards increased office visits in June (-21.9% compared to 2019), this again decreased to -35% in July 2020. The proportion of visits conducted by video began at 16.6% in the first week after California's shelter-in-place order in March, peaked at a high rate of 43.4% in April, and remained at a rate of 33.8% in August. We focused on variability by specific patient subgroups when telemedicine was offered and used prevalently during early pandemic in April. Based on age, the younger cohorts, 18-50 and 51-64 year olds, were more likely to utilize video visit at 50.6%, and 50.6% compared to only 38.0% and 36.7% of the older groups (65-75 and 76+ years old, p<0.001). In fact, the largest discrepancy, 21% difference between the younger vs older groups, was observed towards the end of April. With respect to race, Asians had the highest use of video visits (51.4%) compared to Hispanic (34.5%) and Black patients (40.3%) in April (p<0.001). Although the gap narrowed over the next 4 months with only a 4% difference by August, these cancelled visits were not recovered in the minority groups. Finally, 44.6% of those who did not require an interpreter utilized video visits as compared to only 19.8% who did require an interpreter (p<0.001). Age and race/ethnicity remain strong predictors of video visit use after adjusting the main and interaction effects of patient characteristics, with Asians 51-64 year old having the highest rate (58%) and Hispanics 76+ year old the lowest rate (30%). Overall office visits have decreased significantly during the COVID-19 pandemic. Older patients, Black patients, Hispanic patients, and patients who required interpreting services were less likely to be treated through video visits. Future studies are needed to better understand the barriers to telemedicine care. [ABSTRACT FROM AUTHOR] Copyright of Gynecologic Oncology is the property of Academic Press Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)