S316 Impact of Social Determinants of Health on Colorectal Cancer Screening and Surveillance in the COVID Reopening Phase

Abstract

Introduction: The coronavirus disease 2019 (COVID-19) pandemic caused a three-month cessation of screening and surveillance colonoscopies at our institution in New York City. There is concern that these delays will exacerbate disparities in access to CRC preventative care. We aimed to measure racial and ethnic disparities in prioritization of colonoscopy for CRC screening or adenoma surveillance during the COVID reopening period. Methods: We identified all outpatients who underwent CRC screening and surveillance colonoscopies during two time periods: (1) June 9, 2019 to September 30, 2019 (pre-COVID) and (2) June 9, 2020 to September 30, 2020 (COVID reopening phase). We recorded the indication for each procedure and patient age, gender, race/ethnicity, primary language, insurance status, and zip code. Multivariable logistic regression was used to determine factors independently associated with undergoing colonoscopy in the COVID reopening era. Results: We identified 1,473 colonoscopies for CRC screening or adenoma surveillance within the specified time periods. 890 colonoscopies occurred in the pre-COVID period and 583 occurred in the COVID reopening period. 342 (38.5%) patients in the pre-COVID cohort underwent colonoscopy for adenoma surveillance (as opposed to CRC screening) versus 257 (44.1%) in the COVID reopening cohort (P=0.031). This difference was statistically significant on multivariable analysis (OR 1.26; 95% CI 1.001-1.58). Black patients comprised 17.4% of the pre-COVID cohort, which declined to 15.3% (P=0.613). On multivariable analysis, there was a trend toward an inverse association between reopening phase colonoscopy and Medicaid insurance status compared with commercial insurance (OR 0.71, 95% CI 0.49-1.04). No significant associations were found between reopening phase colonoscopy and age, race/ethnicity, primary language, or zip code on multivariable analysis. Conclusion: During the COVID reopening period, colonoscopies for CRC fell by over one third with significantly more surveillance compared to screening procedures. Non-white patients and non-English speakers comprised a shrinking proportion of people undergoing colonoscopy in the COVID reopening period. While rates of colonoscopy varied among patients of different races/ethnicities and primary language, no significant difference was found between the pre-COVID and COVID reopening cohorts.Table 1.: Multivariable Logistic Regression of Factors Associated with Undergoing Colonoscopy in the COVID Reopening Phase (June-September 2020).