B0164 - Impact of COVID-19 on Trends and Healthcare Disparities on Utilization of Screening Colonoscopy

Monday, October 24, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Rajat Garg, MD

Cleveland Clinic Foundation
Cleveland, Ohio

Rajat Garg, MD¹, Vidhi Patel, MD², Amandeep Singh, MD¹, Priya Sasankan, MD, MBA¹, John McMichael, PhD¹, Prashanthi Thota, MD³, Madhusudhan Sanaka, MD⁴
¹Cleveland Clinic Foundation, Cleveland, OH; ²Cleveland Clinic, Cleveland, OH; ³Cleveland Clinic, Cleveland, OH; ⁴Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH

Introduction: Screening colonoscopy is the cornerstone of colorectal cancer (CRC) prevention. In March 2020, all elective outpatient procedures were halted by Ohio public health authorities. In this study, we aimed to study the impact of COVID-19 on trends and disparities in screening colonoscopy utilization.

Methods: We identified all patients who underwent colonoscopy at Cleveland Clinic Ohio facilities in 2019 to 2021 from July 1^st to December 31^st respective year. The timeline of July 1^st to December 31^st was selected based on lockdown which lasted till the end of June 2020 in Ohio and to compare the factors before, immediately after, and a year after COVID lockdown to understand its long-term impact. We then calculated rates of screening colonoscopy and factors associated with colonoscopy utilization during the study periods of each year.

Results: Among the total of 68206 colonoscopies, 23316 (34.2%) were screening colonoscopies. The rate of screening colonoscopy significantly declined in 2020 (31.2%) and then increased to 37.2% in 2021 as compared to 34.8% in 2020 (p< 0.001) (Figure 1). The mean age of patients significantly went down after the COVID pandemic (p< 0.001), but proportion of seniors (age >65) and the male: female ratio remained the same. In Caucasians, the rate of colonoscopy initially declined in 2020 (74.2%) then increased over 2019 (46%) levels in 2021 (76.9%) whereas utilization of colonoscopy in African Americans initially increased in 2020 (18.9%) and then decreased to even less than 2019 (16.5%) in 2021 (15.9%) (p< 0.001) (Table 1). Patients with private insurance, the highest quartile of median household income, and education had increasing rates of colonoscopy (p< 0.001) in 2020 and 2021. Patients who had ≥2 polyps (12.2%, 13.6% and 15.1%) and adenomas (21.5%, 22.3% and 23.7%) on screening colonoscopy significantly increased from 2019 to 2021 (p< 0.05) (Figure 1). Fortunately, there was no significant increase noted in rates of advanced adenomas (p=0.48) and colorectal cancer (p=0.45) (Figure 1).

Discussion: The pandemic exacerbated preexisting healthcare disparities in colonoscopy utilization which have continued to persist in 2021. The number of polyps and adenomas detected on screening colonoscopy has significantly increased in the post-pandemic lockdown period but that did not translate into excess advanced adenoma detection or CRC rates. This data will assist current and future efforts to increase the uptake of CRC screening, especially in marginalized populations.

Figure: Figure 1: Trends of screening colonoscopy, polyps >=2, adenomas, advanced adenomas, and new diagnosis of CRC in 2019, 2020 and 2021 study period

Table 1: Demographics, socioeconomic and clinical factors in each year’s study period.
Factor	2019 (N=7905)	2020 (N=6737)	2021 (N=8674)	p-value
Age (mean ± sd)	59.8 ± 8.6	59.6 ± 8.9	58.9 ± 9.3	< 0.001
Age >=65	2275 (28.8%)	1871 (27.8%)	2472 (28.5%)	0.38
Sex				0.97
Male	3648 (46.1%)	3107 (46.1%)	4014 (46.3%)
Female	4257 (53.9%)	3630 (53.9%)	4660 (53.7%)
Race				< 0.001
Caucasians	6004 (76%)	4999 (74.2%)	6672 (76.9%)
African Americans	1303 (16.5%)	1271 (18.9%)	1381 (15.9%)
Others	598 (7.6%)	467 (6.9%)	621 (7.2%)
Insurance type				< 0.001
Medicare	1965 (24.9%)	1619 (24%)	1868 (21.5%)
Medicaid and other public	435 (5.5%)	491 (7.3%)	541 (6.2%)
Private	4662 (59%)	4061 (60.3%)	5641 (65%)
No insurance	843 (10.7%)	566 (8.4%)	624 (7.2%)
Education level (% high school grads in zip code)				< 0.001
Q1< 88	1905 (22.8%)	1557 (24.1%)	1768 (21.3%)
Q2 >=88 to < 92.5	1815 (24.3%)	1503 (23.3%)	1923 (23.1%)
Q3 >= 92.5 to < 94	1714 (22.9%)	1549 (22.6%)	1942 (23.3%)
Q4 >= 94	2237 (29.9%)	1935 (30%)	2686 (32.3%)
Median household income				< 0.001
Q1 < 43449	1647 (22%)	1544 (23.9%)	1715 (20.6%)
Q2 >=43449 to < 55969	1837 (24.6%)	1532 (23.7%)	1964 (23.6%)
Q3 >= 55969 to < 67917	1889 (25.3%)	1569 (24.3%)	2154 (25.9%)
Q4 >= 67917	2098 (28.1%)	1809 (28%)	2486 (29.9%)
Tobacco Use	699 (8.8%)	636 (9.4%)	827 (9.5%)	0.13
Alcohol use	5033 (63.7%)	4310 (64%)	5747 (66.3%)	0.001
Illicit drug use	259 (3.3%)	245 (3.6%)	326 (3.8%)	0.22
Preferred language				0.5
English	7732 (97.8%)	6613 (98.2%)	8489 (97.9%)
Spanish	83(1%)	60 (0.9%)	81 (0.9%)
Others	90 (1.1%)	64 (0.9%)	104 (1.2%)
BMI	29.6 ± 6.4	29.8 ± 6.5	29.7 ± 6.5	0.52
Number of polyps				< 0.001
0	4483 (56.7%)	3770 (56%)	4643 (53.5%)
1	2456 (31.1%)	2049 (30.4%)	2721 (31.4%)
>=2	966 (12.2%)	918 (13.6%)	1310 (15.1%)
Adenoma	1697 (21.5%)	1503 (22.3%)	2059 (23.7%)	0.002
Advanced Adenoma	361 (4.6%)	324 (4.8%)	382 (4.4%)	0.48
Cancer	12 (0.2%)	12 (0.2%)	9 (0.1%)	0.45

Table: Table 1: Demographics, socioeconomic and clinical factors in each year’s study period.

Disclosures:

Rajat Garg indicated no relevant financial relationships.

Vidhi Patel indicated no relevant financial relationships.

Amandeep Singh indicated no relevant financial relationships.

Priya Sasankan indicated no relevant financial relationships.

John McMichael indicated no relevant financial relationships.

Prashanthi Thota indicated no relevant financial relationships.

Madhusudhan Sanaka indicated no relevant financial relationships.

Rajat Garg, MD¹, Vidhi Patel, MD², Amandeep Singh, MD¹, Priya Sasankan, MD, MBA¹, John McMichael, PhD¹, Prashanthi Thota, MD³, Madhusudhan Sanaka, MD⁴. B0164 - Impact of COVID-19 on Trends and Healthcare Disparities on Utilization of Screening Colonoscopy, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.