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Disparities in Colorectal Cancer Screening Before and After the Onset of the COVID Pandemic

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Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

Background

Colorectal cancer (CRC) screening is underutilized among those with lower socioeconomic status and in racial and ethnic minoritized populations who have been disproportionately impacted by COVID.

Objective

To compare disparities in CRC screening before and after the onset of the COVID pandemic among privately insured individuals.

Design

Retrospective cohort study using deidentified claims data from the USA between January 1, 2017, and December 31, 2022.

Participants

Blue Cross Blue Shield beneficiaries aged 50–75 years with average risk of CRC.

Main Measure(s)

Mean screening use was compared by demographic and area-level socioeconomic factors between the periods preceding (January 1, 2017 to February 28, 2020) and following (July 1, 2020 to December 31, 2022) the onset of the COVID pandemic. Difference-in-differences analysis was used to evaluate changes in screening differences.

Results

Our study included 21,724,223 beneficiaries. Compared to males, females had higher screening in both periods (p < 0.05), and this sex difference in screening increased 1.63% (95% confidence interval [CI]: 1.32%, 1.94%) following the onset of the pandemic. Compared to residents in areas with high socioeconomic status (SES), low SES area residents had lower screening (p < 0.001) during both periods. Furthermore, this difference grew 4.32% (95% CI, 3.76%, 4.88%) during the post-onset period. Metropolitan area residents had higher screening than non-metropolitan area residents during both periods (p < 0.001); however, this difference decreased 0.77% (95% CI, 0.34%, 1.20%) during the post-onset period. Among beneficiaries with high risk of CRC, the difference in screening based on social deprivation index and metropolitan area status increased 6.99% (95% CI, 5.77%, 8.20%) and 1.82% (95% CI, 0.88%, 2.74%), respectively.

Conclusions

Among privately insured individuals, CRC screening after the COVID pandemic recovered unevenly based on sex, area-level socioeconomic measures, and metropolitan area status, with pre-pandemic disparities persisting and even worsening for some of the factors.

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Data Availability:

We obtained access to the BCBS Axis data through an institutional agreement on research collaboration between Yale University and BCBS and a proposal describing the work presented in this manuscript that was approved by the BCBS. We are not allowed to share the raw data as stipulated by the institutional agreement and the proposal. Interested investigators should contact BCBS directly for potential data access. On the other hand, we are open to sharing our analytical methods and statistical programs with any researchers who contact us.

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Funding

Sunny Siddique was supported by the National Cancer Institute of the National Institutes of Health under award number 1F31CA281335-01 (GRANT13694178). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Author information

Authors and Affiliations

  1. Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, USA

    Sunny Siddique MPH, Rong Wang PhD & Xiaomei Ma PhD

  2. Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale Cancer Center, New Haven, USA

    Sunny Siddique MPH, Rong Wang PhD, Jacquelyne J. Gaddy MD, MSc, MSCR, Cary P. Gross MD & Xiaomei Ma PhD

  3. Department of Medicine (Medical Oncology), Yale School of Medicine, New Haven, USA

    Jacquelyne J. Gaddy MD, MSc, MSCR

  4. Department of Medicine (Hematology/Oncology), Yale School of Medicine, New Haven, USA

    Jessica M. Stempel MD

  5. Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA

    Joshua L. Warren PhD

  6. Department of Medicine (General Medicine), Yale School of Medicine, New Haven, USA

    Cary P. Gross MD

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Correspondence to Sunny Siddique MPH.

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Conflict of Interest:

Dr. Cary Gross has received research funding from the National Comprehensive Cancer Network (with funding provided to NCCN by Astra Zeneca), and Genentech, as well as research funding from Johnson & Johnson to help develop and implement new approaches to sharing clinical trial data. Dr. Xiaomei Ma served as a consultant for Bristol Myers Squibb. All other coauthors have no conflicts of interest to declare.

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The funders did not have any role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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Prior Presentations: Poster presentation at the 16th American Association of Cancer Research (AACR) Conference on The Science of Cancer Health Disparities in Racial/Ethnic Minorites and the Medically Underserved, Sept. 29–Oct. 2, 2023, Orlando, FL.

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Siddique, S., Wang, R., Gaddy, J.J. et al. Disparities in Colorectal Cancer Screening Before and After the Onset of the COVID Pandemic. J GEN INTERN MED (2024). https://doi.org/10.1007/s11606-024-09153-3

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