ABSTRACT
The impact of COVID-19 infection and the indirect effects of the pandemic on the trajectory of CKD is unknown. We performed a retrospective study using de-identified administrative claims data for Medicare Advantage enrollees with CKD Stages G3-4 in 2018-2021. Rapid kidney function decline (RFKD) was defined as a decrease in eGFR of >5ml/min/1.73m2 per year. RFKD was compared for the overall cohort during the pre-pandemic period (Jan 1, 2018 to Feb 29, 2020) to RFKD for the pandemic period (March 1, 2020 to August 31, 2021), and comparatively between enrollees with and without a diagnosed COVID-19 infection. We also evaluated factors independently associated with RKFD. Of 90,734 enrollees with available data, mean age was 75 years, 59% were males, 70% were White;62%, 30%, 8% had CKD G3a, 3b, and 4, respectively. RKFD was observed in 20.4% of enrollees in the pre-pandemic period and in 26.8% during the pandemic. Overall, COVID infection was diagnosed in 8.7% of enrollees. RKFD was observed in 28.2% of those with a COVID-19 diagnosis and 25.1% of those without (p value < 0.05). Factors associated with increased odds of RKFD in the pandemic included Black or Hispanic race/ethnicity, RKFD in the pre-pandemic period, and documented COVID infection;advancing CKD stage was inversely associated with RRFD (Figure). The COVID-19 pandemic resulted in more than a quarter of the population experiencing rapid kidney function decline for individuals with CKD, irrespective of COVID-19 infection. The downstream impact of pandemic-related eGFR decline on health outcomes, such as cardiovascular disease, kidney failure or mortality, requires further study. (Figure Presented)
ABSTRACT
Background Digital breast tomosynthesis (DBT), also called 3D mammography, was first approved by the Federal Drug Administration in 2011. The goal of 3D mammography is to improve accuracy compared to 2D digital mammography (DM), by increasing sensitivity and decreasing recall rates. To capture the broad utilization of DBT in populations receiving both screening and diagnostic imaging, this analysis investigates DBT usage over time in a longitudinal sample from 2016 through 2020 for adult women ranging from 18-74 years of age. Methods Retrospective analyses were conducted using de-identified administrative claims data from a large national U.S. health insurer. The study cohort consisted of women who were continuously enrolled in a commercial or Medicare Advantage plan from 1/2016 to 12/2020 and aged 18 to 74 years old as of 2016. All procedures were identified based on Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes. For each study year, receipt of breast cancer screening with DM (S-DM) or including DBT (S-DBT) were captured. Receipt of DM and DBT not specified for screening based on CPT code descriptions were categorized as diagnostic, D-DM and D-DBT respectively. Women that received both DBT and DM in the same year were included in the DBT group. In addition, women who received MRI and ultrasound were also captured. Rates of each procedure by study year, insurance type, and age categories that align with recommended screening guidelines (<40 years old, 40-49 years old and 50-74 years old) were examined. Results Approximately 3.8 million women met study criteria;85% were commercially insured and 15% were Medicare Advantage. Table 1 shows rates of adult women who received mammography, MRI and ultrasound over the study period. About 74% of study subjects receiving screening were 50-74 years old at the start of the study period, 25% were 40-49 years and 1% were under 40 years old. In 2020, there were fewer women (3%-13%) receiving imaging procedures compared to counts in 2019. During the 5-year study period, there was a 3.5-fold increase in the number of women who received S-DBT. In 2016, 23% of women who received a screening mammogram received S-DBT and by 2020, this percent increased to 82%. The percent of women who received a diagnostic mammogram using D-DBT compared to D-DM also increased overtime;29% of women received a D-DBT in 2016 and this increased to 77% in 2020. The number of women with receipt of ultrasound and MRI were similar in each study year. The percent diagnostic/screening tests (including DBT and DM) were in the range of 18.5%-20.2% each year. Conclusion Among this cohort of women who were continuously enrolled in the health plan throughout the 5-year study period, this analysis shows that screening and diagnostic DBT utilization rates increased from 2016 to 2020 while DM screening and diagnostic imaging utilization concomitantly decreased. The percentages of women that received S-DBT and D-DBT were highest in 2020, even though 8%-13% fewer women had evidence of mammography than in 2019, which is largely due to COVID-19 related healthcare service disruptions. The rate of diagnostic tests as a percent of screening tests did not decrease with the adoption of DBT. Further analyses investigating rates of follow-up procedures and downstream costs are warranted.