S3246 The Impact of COVID-19 on Colorectal Screening Adherence at a Large Institution

Abstract

Introduction: Colorectal cancer (CRC) is the second-leading cause of death in the US. Despite the National Colorectal Roundtable goal of achieving 80% adherence, CRC screening remains underutilized, especially in the underinsured populations. Screening programs have been heavily disrupted during the COVID-19 pandemic. We aimed to quantify the impact of this disruption on the already existing disparities in CRC screening especially as it pertains to those ethnic groups underserved in medicine. Methods: Data for this project was abstracted from a health system electronic health record (EHR). Patients were identified 1 year before and after COVID-19 precautions began, using March 1, 2020 as the inflection point. For each year, the primary inclusion criterion was an ordered colonoscopy. The outcome of interest was colonoscopy receipt. Self-reported race was obtained from the EHR. Differences by year and race were assessed using Chi-square analysis. Results: A cohort of 816 patients between age 45 and 75 for who a colonoscopy was ordered were selected from EHR at a single large institution. 538 patients were in the Pre-COVID group, and 278 were in the post-COVID group (Table). Of these two groups 47.9% (n = 258) had colonoscopy performed – a 59% reduction. In the Post-COVID group, this was 37.7% (n = 105). This reduction in colonoscopies performed persisted across all race groups. For White patients, it was 55%, Asian Americans had a 57% reduction, and African Americans had a 66% reduction. Conclusion: The true impact of COVID-19 on colorectal cancer is yet to be uncovered as future mortality estimates from CRC are ongoing. Due to widespread closure of endoscopy centers and delay in screening, we believe that the pandemic worsened the screening disparities most prevalent among minority populations. Our retrospective analysis over the last two years points to the drastic reduction of screening for all races, and especially for African Americans. As life gradually returns to normal, it would be interesting to see how the past year has impacted the incidence and prevalence of CRC.Figure 1.: Difference in colonoscopies performed per ethnic group before and during COVID-19 pandemic.