Purpose: To identify patient and facility characteristics affecting mammography screening volumes during the COVID-19 pandemic.
Materials and Methods: Screening mammogram volumes were reviewed before (10/21/2016-3/16/2020) and after (6/17/2020-7/31/2021) a COVID-19 state-mandated shutdown of screening examinations (3/17/2020-6/16/2020). A segmented quasipoisson generalized linear model adjusting for seasonality through sine-cosine terms was fit in the style of an interrupted time series to measure screening mammography volume trends over time. The slopes of the lines before and after the shutdown and the volumes immediately before and after shutdown were compared for each variable (age, race, language, insurance, risk factor for severe disease, and examination location).
Results: Overall volume of screening examinations increased at 66 examinations per month before the COVID-19 shutdown and decreased at the rate of 78 mammograms per month after the shutdown (p=0.001). In subgroup analysis, a significant decrease in volume was observed among patients age ≥50 years (slope = +57 before vs. -76 after, p<0.001 non-Hispanic Whites (+56 vs. -88, p<0.001), English speakers (+63 vs. -80, p<0.001), beneficiaries of Medicare or other insurance (+22 vs. -32, p<0.001; +39 vs. -51, p=0.002), and those screened at hospital-based location (+48 vs. -100, p<0.0001), but not in patients <50 years, other races/ethnicities, non-English speakers, Medicaid beneficiaries, and those screened at outpatient locations. Furthermore, percent change in slope before versus after the shutdown was significantly different between patient age ≥50 years compared to age <50 years (-233% vs. -111%, p=0.012); non-Hispanic Whites compared to others (-257% vs. +17%, p=0.023); and hospital-based location compared to outpatient location (-308% vs. +33%, p<0.001). Presence versus absence of one or more risk factor for severe COVID-19 disease was not significantly associated with differences of volume trend.
Conclusion: Screening mammogram volume at more than a year after COVID-19 state-mandated shutdown has continued to decline for patients ≥50 years, non-Hispanic Whites, English speakers, those with Medicare or other insurance, and those imaged at a hospital-based location.
Clinical Relevance Statement: Patient and facility characteristics are associated with screening mammogram volume trend since the COVID-19 shutdown, and some subgroups may benefit from targeted outreach and education.
