Disparate recovery of cancer screenings by demographic in traditional Medicare post-pandemic.

Abstract

11090 Background: Cancer screenings are a pillar of public health and early diagnosis of cancer (doi.org/10.1016/j.soncn.2017.02.002) The COVID 19 pandemic impacted access to outpatient services, such as cancer screenings (doi:10.1001/jamaoncol.2022.5481) Our study aims to assess how this impact and the recovery following the 2020 pandemic differed by race and ethnicity in Traditional or Fee-For-Service Medicare (TM). Methods: Claims data on a 5% sample of TM included 1.3 million beneficiaries eligible for colorectal (CRC) cancer screenings and 736,000 females eligible for breast cancer (BC) screenings. This sample was followed for a multi-year cross sectional analysis using Medicare Beneficiary Summary Files from 2017 to 2023. Claims were linked to Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes to monitor annual utilization rates of screenings by demographic for BC and CRC. Utilization proportions were estimated based on the eligible population categorized by race/ethnicity and sex for BC. Results: Overall, screenings decreased in 2020 during the first year of the pandemic. BC screenings recovered quickly to pre-pandemic levels, comparing the 2019 pre-pandemic (35%) to 2021 post-pandemic (35%) rates overall in our TM sample. This was mirrored for women of non-Hispanic white (pre/post 36%), African American (pre: 33% post: 33%) and Asian/Pacific Islander (API; pre/post: 27%) groups in TM. These demographics nearly returned to 2019 rates by the 2 nd year of the pandemic in 2021. American Indian/Alaska Natives (AIAN; pre: 22% post: 21%) and Hispanic women (pre: 27% post: 25%), however, did not return to pre-pandemic rates until 2022 and 2023 respectively. AIAN and Hispanic women also had the lowest utilization of BC screenings throughout our study period. CRC screenings had a slower recovery below 2019 levels (13%) in 2021 (12%), but recovering by 2023 (13%). This was mirrored across most racial demographics with the slowest recovery amongst AIAN (pre: 8%, post: 7%) and Hispanic (pre: 13%, post: 11%) beneficiaries. AIAN and African American beneficiaries displayed the lowest rates of CRC screenings throughout our study. Conclusions: Past research displayed decreased cancer screenings at the outset of the pandemic in 2020. 2,3 While services generally rebounded by 2021, the rate of recovery differed not only by screening type but also by demographic. BC screenings returned overall to 2019 rates by 2021. Hispanic and AIAN women lagged in recovery and utilized the lowest rates of BC screenings annually relative to the average TM beneficiary. CRC screening utilization saw a slower recovery, narrowly meeting 2019 levels by 2023. The lowest rates of CRC screenings were noted amongst African American and AIAN beneficiaries, who also struggled to recover to pre-pandemic (2019) levels by 2023. Our data highlights the disparate effects of the pandemic, especially for CRC screenings and certain racial demographics.