Exacerbation of Inequities in Use of Diagnostic Radiology During the Early Stages of Reopening After COVID-19

Lacson, Ronilda; Shi, Junzi; Kapoor, Neena; Eappen, Sunil; Boland, Giles W.; Khorasani, Ramin

doi:10.1016/j.jacr.2020.12.009

Cited by 19 publications

(16 citation statements)

References 23 publications

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“…Notably, substantially fewer cancers were diagnosed in Asian, Hispanic, and non-Hispanic Black women compared to non-Hispanic White women. These results are consistent with prior studies which have found racial/ethnic disparities in breast cancer screening and diagnostic imaging use during the pandemic ( 6 , 22 , 23 ). Greater pandemic-related delays have also been observed among Asian and Hispanic individuals for imaging in general ( 15 ) and for individuals residing in communities with high levels of poverty ( 15 , 24 ).…”

Section: Discussionsupporting

confidence: 92%

“…These results are consistent with prior studies which have found racial/ethnic disparities in breast cancer screening and diagnostic imaging use during the pandemic ( 6 , 22 , 23 ). Greater pandemic-related delays have also been observed among Asian and Hispanic individuals for imaging in general ( 15 ) and for individuals residing in communities with high levels of poverty ( 15 , 24 ). While it is not possible to definitively identify the factors driving these disparities based on our results, the pandemic has disproportionately impacted minoritized racial/ethnic groups in many ways that could reduce access to breast cancer care.…”

Section: Discussionsupporting

confidence: 92%

“…However, despite the swift return to pre-pandemic monthly volumes, as of July 2020 year-to-date screening and diagnostic mammography examinations in the Breast Cancer Surveillance Consortium (BCSC) were only 66% and 80% of expected volumes, respectively ( 6 ), indicating a substantial deficit in breast cancer screening accumulated during the early stage of the pandemic. Moreover, these deficits were largest in Hispanic and Asian women ( 6 ), adding to existing evidence that the COVID-19 pandemic has disproportionately impacted minoritized racial and ethnic groups ( 15 ).…”

Section: Introductionmentioning

confidence: 98%

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Breast Biopsy Recommendations and Breast Cancers Diagnosed during the COVID-19 Pandemic

et al. 2022

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 98%

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Breast Biopsy Recommendations and Breast Cancers Diagnosed during the COVID-19 Pandemic

et al. 2022

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“…. While a study confirmed that the COVID-19 pandemic further exacerbated pre-existing underutilization of diagnostic imaging among the underserved [10] , there is currently no study dedicated to potential disparities in breast cancer screening during COVID-19.…”

Section: Introductionmentioning

confidence: 99%

Patients characteristics related to screening mammography cancellation and rescheduling rates during the COVID-19 pandemic

et al. 2021

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Purpose To identify patient characteristics associated with screening mammography cancellations and rescheduling during the COVID-19 pandemic. Methods Scheduled screening mammograms during three time periods were retrospectively reviewed: state-mandated shutdown (3/17/2020-6/16/2020) during which screening mammography was cancelled, a period of 2 months immediately after screening mammography resumed (6/17/2020-8/16/2020), and a representative period prior to COVID-19 (6/17/2019-8/16/2019). Relative risk of cancellation before COVID-19 and after reopening was compared for age, race/ethnicity, insurance, history of chronic disease, and exam location, controlling for other collected variables. Risk of failure to reschedule was similarly compared between all 3 time periods. Results Overall cancellation rate after reopening was higher than before shutdown (7663/16595, 46% vs 5807/15792, 37%; p < 0.001). Relative risk of cancellation after reopening increased with age (1.20 vs 1.27 vs 1.36 for ages at 25th, 50th, and 75th quartile or 53, 61, and 70 years, respectively, p < 0.001). Relative risk of cancellation was also higher among Medicare patients (1.41) compared to Medicaid and those with other providers (1.26 and 1.21, respectively, p < 0.001) and non-whites compared to whites (1.34 vs 1.25, p = 0.03). Rescheduling rate during shutdown was higher than before COVID-19 and after reopening for all patients (10,658/13593, 78%, 3569/5807, 61%, and 4243/7663, respectively, 55%, p < 0.001). Relative risk of failure to reschedule missed mammogram was higher in hospitals compared to outpatient settings both during shutdown and after reopening (0.62 vs 0.54, p = 0.005 and 1.29 vs 1.03, p < 0.001, respectively). Conclusion Minority race/ethnicity, Medicare insurance, and advanced age were associated with increased risk of screening mammogram cancellation during COVID-19.

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“…Moreover, we must assess whether there are unintended consequences associated with the abrupt reduction in imaging, e.g., delayed diagnoses and treatments, and excess mortality. For example, it has been documented that the number of treated injuries was reduced during the first weeks of the pandemic [ 35 ], that the reduction in imaging exacerbated inequities [ 36 ], had economic consequences [ 37 ], and influenced radiology trainees [ 38 ]. However, it is too early to assess the implications of the reduction in imaging on people’s health.…”

Section: Discussionmentioning

confidence: 99%

What can we learn from the SARS-COV-2 pandemic about the value of specific radiological examinations?

Hofmann

Andersen

Kjelle

2021

BMC Health Serv Res

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Background The SARS-COV-2 pandemic provides a natural intervention to assess practical priority setting and internal evaluation of specific health services, such as radiological services. Norway makes an excellent case as it had a very low infection rate and very few cases of COVID-19. Accordingly, the objective of this study is to use the changes in performed outpatient radiological examinations during the first stages of the SARS-COV-2 pandemic to assess the practical evaluation of specific radiological examinations in Norway. Methods Data was collected retrospectively from the Norwegian Health Economics Administration (HELFO) in the years 2015–2020. Data included the number of performed outpatient imaging examinations at public hospitals and private imaging centers in Norway and was divided in to three periods based on the level of restrictions on elective health services. Results were analyzed with descriptive statistics. Results In the first period there was a 45% reduction in outpatient radiology compared to the same time period in 2015–2019 while in period 2 and 3 there was a 25 and 6% reduction respectively. The study identified a list of specific potential low-value radiological examinations. While some of these are covered by the Choosing Wisely campaign, others are not. Conclusion By studying the priority setting practice during the initial phases of the pandemic this study identifies a set of potential low value radiological examinations during the initial phases of the SARS-COV-2 pandemic. These examinations are candidates for closer assessments for health services quality improvement.

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Exacerbation of Inequities in Use of Diagnostic Radiology During the Early Stages of Reopening After COVID-19

Cited by 19 publications

References 23 publications

Breast Biopsy Recommendations and Breast Cancers Diagnosed during the COVID-19 Pandemic

Breast Biopsy Recommendations and Breast Cancers Diagnosed during the COVID-19 Pandemic

Patients characteristics related to screening mammography cancellation and rescheduling rates during the COVID-19 pandemic

What can we learn from the SARS-COV-2 pandemic about the value of specific radiological examinations?

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