IMPACT OF THE COVID-19 PANDEMIC ON RACIAL AND SOCIO-ECONOMIC DISPARITIES ON RECEIVING COLORECTAL CANCER SCREENING RECOMMENDATIONS IN THE UNITED STATES.

Background: Although colorectal cancer (CRC) screening has been recommended for decades, about one-third of eligible individuals are not up-to-date with screening in the US. The COVID-19 pandemic has worsened this situation. Specific recommendations from health care providers have been found to have a critical role in promoting screening. We aimed to explore the impact of COVID-19 pandemic on CRC screening recommendations and its distinct effects on different populations.
Method: We analyzed the 2019 and 2021 datasets from the National Health Interview Survey (NHIS) in a retrospective cross-sectional study. Using a multistage probability design, the NHIS represents a broad geographical representation of the country. US adults aged 50-75 with no prior CRC and not up-to-date with CRC screening who had available information for CRC screening recommendations were included (N= 4270 [representing 31,665,798] and 3634 [representing 28,496,028] in 2019 and 2021, respectively). The 50-75 age group was considered to have better consistency between 2019 and 2021. A multivariable logistic model was used to identify factors associated with the likelihood of receiving screening recommendations from a provider in the past 12 months. In addition to analysis of the pooled dataset, we conducted separate analyses for 2019 and 2021 to determine if the COVID pandemic disproportionally impacted screening recommendations for specific populations. Weighted frequencies, odds ratio (OR) and confidence interval were estimated.
Results: 1,015 (22.22%) eligible individuals received recommendations for CRC screening in 2019, whereas 660 (17.9%) received them in 2021 (adjusted OR = 0.81, p<.001). Factors associated with less likelihood of receiving a recommendation both in 2019 and 2021 included low income, lack of insurance, racial and ethnic minorities, and no access to a usual care facility. Disparities related to race and insurance coverage became more pronounced in 2021 (Table 1). Also, the higher likelihood of referral in patients with higher education in 2019 was not seen in 2021. Opportunistic referrals were generated from urgent office visits in 2019 vs. emergent hospital visits in 2021.
Conclusion: A lower proportion of eligible individuals received recommendations for CRC screening from a provider during the COVID-19 pandemic in 2021 compared to 2019. While there was a disparity gap in 2019 in individuals with low socio-economic status, ethnic minorities, and those with no access to usual care facility, the gap widened further among ethnic minorities and the uninsured during the COVID-19 pandemic. Targeted efforts are even more needed as a result of the pandemic in order to decrease the disparities gap in CRC screening.