ENDOSCOPY COVID-19 TESTING REQUIREMENTS DISPROPORTIONATELY AFFECT BLACK PATIENTS

ABSTRACT

Background: The COVID-19 pandemic has led to major disruptions in healthcare and delays in endoscopy. While recent AGA guidelines suggest against routine pre-endoscopy SARSCoV2 testing, many endoscopy practices continue to require testing of all asymptomatic individuals. We hypothesized that SARS-CoV2 testing may disproportionately affect minority groups. The aim of this study was to assess racial differences in endoscopy cancellation rates attributable to SARS-CoV2 testing requirements. Methods: We conducted a retrospective chart review of cancelled endoscopic procedures between 3/1/21 to 9/7/21 from our hospital which mandated a negative SARS-CoV2 RT-PCR test within 72-hours prior to endoscopy. Data was collected on age, race (based on self-report), gender, procedure type/location, primary language, indication, and source of referral. Cancellations related to SARS-CoV2 testing included test not completed, test not resulted, patient declined to obtain test, or positive test result. Multiple logistic regression was used to control for potential confounders on race and cancellation. Statistics were performed in JMP Pro 14.0.0. This project was IRB approved. Results: Of 847 cancelled procedures, 300 were randomly selected for chart review (for feasibility purposes). After excluding repeat patients and erroneous cancellations, 255 cases remained for analysis (Table 1). SARS-CoV2 testing requirements accounted for 19% of cancellations (Table 2). Of 112 completed tests, only 7 were positive leading to procedure cancellation. Non-Hispanic Black patients were significantly more likely to have procedure cancellations related to SARS-CoV2 testing (OR 3.4, 95% CI 1.7, 6.7). This group was also less likely to present for their procedure (OR 2.3, 95% CI 1.2, 4.1);however, there was no difference in provider initiated cancellations. Other factors including age, gender, procedure type, procedure location, primary language, gastroenterology referral, and indication (screening or diagnostic) were not associated with testing-related cancellations. Controlling for potential confounders of age, gender, endoscopy location, and language did not change the association of race and testing-related cancellations. Discussion: Blacks had higher rates of pre-endoscopy cancellations due to SARS-CoV2 testing requirements compared to non-Blacks which may lead to further delays in care. Similar to prior studies, Blacks also had higher no show rates for endoscopy, which is partly explained by socioeconomic factors. However, the additional requirement of pre-procedure testing disproportionately impacted Black patients. Health care systems mandating pre-endoscopy testing should recognize how this requirement may worsen inequities in care and contribute to poor health outcomes among people of color or other marginalized groups. (Table Presented) (Table Presented)