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IDENTIFICATION OF POPULATIONS WITH HINDERED ACCESS TO COLORECTAL CANCER SCREENING AND SURVEILLANCE COLONOSCOPIES DURING THE COVID-19 PANDEMIC
Gastroenterology ; 162(7):S-282, 2022.
Article in English | EMBASE | ID: covidwho-1967272
ABSTRACT

Background:

The COVID-19 pandemic increased barriers to accessing preventative healthcare, jeopardizing previous progress to reduce colorectal cancer (CRC) morbidity and mortality. This study identifies populations with hindered access to CRC screening and surveillance colonoscopies during the pandemic and whether these disparities are being rectified as healthcare adapts.

Methods:

Colonoscopies during six-month intervals, July 1- Dec 31, 2019 and 2020 (pre-pandemic and pandemic) and Jan 1-June 30, 2021 (pandemic), were reviewed. Patients were categorized based on procedure indication, demographics, Social Vulnerability Index (SVI), and Charlson Comorbidity Index (CCI). SVI estimates communities' ability to prevent human and financial loss in a disaster on a scale from 0- 1. Higher SVI indicates increased vulnerability.

Results:

2387 (2019) colonoscopies prepandemic and 2585 (2020) and 2563 (2021) during the pandemic were identified, of which, 1066, 1167, and 820 (Chi-square, p<.0001) were completed for CRC screening and surveillance respectively. The total average (avg) CRC risk patients presenting for first colonoscopy declined during the pandemic, from 232 pre-pandemic to 190 in 2020 and 145 in 2021 (p<.0001). Fewer of these patients presented from highly vulnerable communities, SVI >0.8, during the pandemic, 39 in 2019 vs 16 in 2020 and 22 in 2021 (p=0.03). Of all screening and surveillance, fewer patients presented from communities with SVI >0.8 during the pandemic, 109 in 2019 versus 69 in 2020 and 78 in 2021 (p=0.0005). Avg CCI of screening and surveillance patients increased each year (ANOVA, 3.67±0.08 vs. 3.92±0.08 vs. 3.98±0.09, p=0.01).

Discussion:

It is important to address the decline in CRC preventative care during COVID-19, especially among avg CRC risk first-time screeners, patients from vulnerable communities, and healthier individuals. If the pandemic persists and this trend continues, there will be an increasing backlog of patients from these vulnerable groups to catch up on. There was moderate improvement in the percent of patients presenting from vulnerable groups in 2021 but the absolute totals remained low. Patients from higher SVI communities may have disproportionately increased hardships during the pandemic preventing them from obtaining preventive healthcare. Emphasis on addressing the social determinants of health will be imperative to promote health in these populations. It is probable that healthier patients with few medical complaints were less likely to see a physician and offered CRC prevention. Those who have not been screened before would not have been contacted by gastroenterology clinics if they were not established patients. To counter these trends, the gastroenterology community should develop a systematic plan to expand use of open access colonoscopies, alternative screening methods and targeted outreach.
Keywords

Full text: Available Collection: Databases of international organizations Database: EMBASE Language: English Journal: Gastroenterology Year: 2022 Document Type: Article

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Full text: Available Collection: Databases of international organizations Database: EMBASE Language: English Journal: Gastroenterology Year: 2022 Document Type: Article