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Racial and socioeconomic inequities in breast cancer screening before and during the COVID-19 pandemic: analysis of two cohorts of women 50 years +
BACKGROUND: Routine screening mammography at two-year intervals is widely recommended for the prevention and early detection of breast cancer for women who are 50 years + . Racial and other sociodemographic inequities in routine cancer screening are well-documented, but less is known about how these...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Nature Singapore
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8976168/ https://www.ncbi.nlm.nih.gov/pubmed/35366175 http://dx.doi.org/10.1007/s12282-022-01352-2 |
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author | Monsivais, Pablo Amiri, Solmaz Robison, Jeanne Pflugeisen, Chaya Kordas, Gordon Amram, Ofer |
author_facet | Monsivais, Pablo Amiri, Solmaz Robison, Jeanne Pflugeisen, Chaya Kordas, Gordon Amram, Ofer |
author_sort | Monsivais, Pablo |
collection | PubMed |
description | BACKGROUND: Routine screening mammography at two-year intervals is widely recommended for the prevention and early detection of breast cancer for women who are 50 years + . Racial and other sociodemographic inequities in routine cancer screening are well-documented, but less is known about how these long-standing inequities were impacted by the disruption in health services during the COVID-19 pandemic. Early in the pandemic, cancer screening and other prevention services were suspended or delayed, and these disruptions may have had to disproportionate impact on some sociodemographic groups. We tested the hypothesis that inequities in screening mammography widened during the pandemic. METHODS: A secondary analysis of patient data from a large state-wide, non-profit healthcare system in Washington State. Analyses were based on two mutually exclusive cohorts of women 50 years or older. The first cohort (n = 18,197) were those women screened in 2017 who would have been due for repeat screening in 2019 (prior to the pandemic’s onset). The second cohort (n = 16,391) were women screened in 2018 due in 2020. Explanatory variables were obtained from patient records and included race/ethnicity, age, rural or urban residence, and insurance type. Multivariable logistic regression models estimated odds of two-year screening for each cohort separately. Combining both cohorts, interaction models were used to test for differences in inequities before and during the pandemic. RESULTS: Significant sociodemographic differences in screening were confirmed during the pandemic, but these were similar to those that existed prior. Based on interaction models, women using Medicaid insurance and of Asian race experienced significantly steeper declines in screening than privately insured and white women (Odds ratios [95% CI] of 0.74 [0.58–0.95] and 0.76 [0.59–0.97] for Medicaid and Asian race, respectively). All other sociodemographic inequities in screening during 2020 were not significantly different from those in 2019. CONCLUSIONS: Our findings confirm inequities for screening mammograms during the first year of the COVID-19 pandemic and provide evidence that these largely reflect the inequities in screening that were present before the pandemic. Policies and interventions to tackle long-standing inequities in use of preventive services may help ensure continuity of care for all, but especially for racial and ethnic minorities and the socioeconomically disadvantaged. |
format | Online Article Text |
id | pubmed-8976168 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Springer Nature Singapore |
record_format | MEDLINE/PubMed |
spelling | pubmed-89761682022-04-04 Racial and socioeconomic inequities in breast cancer screening before and during the COVID-19 pandemic: analysis of two cohorts of women 50 years + Monsivais, Pablo Amiri, Solmaz Robison, Jeanne Pflugeisen, Chaya Kordas, Gordon Amram, Ofer Breast Cancer Original Article BACKGROUND: Routine screening mammography at two-year intervals is widely recommended for the prevention and early detection of breast cancer for women who are 50 years + . Racial and other sociodemographic inequities in routine cancer screening are well-documented, but less is known about how these long-standing inequities were impacted by the disruption in health services during the COVID-19 pandemic. Early in the pandemic, cancer screening and other prevention services were suspended or delayed, and these disruptions may have had to disproportionate impact on some sociodemographic groups. We tested the hypothesis that inequities in screening mammography widened during the pandemic. METHODS: A secondary analysis of patient data from a large state-wide, non-profit healthcare system in Washington State. Analyses were based on two mutually exclusive cohorts of women 50 years or older. The first cohort (n = 18,197) were those women screened in 2017 who would have been due for repeat screening in 2019 (prior to the pandemic’s onset). The second cohort (n = 16,391) were women screened in 2018 due in 2020. Explanatory variables were obtained from patient records and included race/ethnicity, age, rural or urban residence, and insurance type. Multivariable logistic regression models estimated odds of two-year screening for each cohort separately. Combining both cohorts, interaction models were used to test for differences in inequities before and during the pandemic. RESULTS: Significant sociodemographic differences in screening were confirmed during the pandemic, but these were similar to those that existed prior. Based on interaction models, women using Medicaid insurance and of Asian race experienced significantly steeper declines in screening than privately insured and white women (Odds ratios [95% CI] of 0.74 [0.58–0.95] and 0.76 [0.59–0.97] for Medicaid and Asian race, respectively). All other sociodemographic inequities in screening during 2020 were not significantly different from those in 2019. CONCLUSIONS: Our findings confirm inequities for screening mammograms during the first year of the COVID-19 pandemic and provide evidence that these largely reflect the inequities in screening that were present before the pandemic. Policies and interventions to tackle long-standing inequities in use of preventive services may help ensure continuity of care for all, but especially for racial and ethnic minorities and the socioeconomically disadvantaged. Springer Nature Singapore 2022-04-02 2022 /pmc/articles/PMC8976168/ /pubmed/35366175 http://dx.doi.org/10.1007/s12282-022-01352-2 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Original Article Monsivais, Pablo Amiri, Solmaz Robison, Jeanne Pflugeisen, Chaya Kordas, Gordon Amram, Ofer Racial and socioeconomic inequities in breast cancer screening before and during the COVID-19 pandemic: analysis of two cohorts of women 50 years + |
title | Racial and socioeconomic inequities in breast cancer screening before and during the COVID-19 pandemic: analysis of two cohorts of women 50 years + |
title_full | Racial and socioeconomic inequities in breast cancer screening before and during the COVID-19 pandemic: analysis of two cohorts of women 50 years + |
title_fullStr | Racial and socioeconomic inequities in breast cancer screening before and during the COVID-19 pandemic: analysis of two cohorts of women 50 years + |
title_full_unstemmed | Racial and socioeconomic inequities in breast cancer screening before and during the COVID-19 pandemic: analysis of two cohorts of women 50 years + |
title_short | Racial and socioeconomic inequities in breast cancer screening before and during the COVID-19 pandemic: analysis of two cohorts of women 50 years + |
title_sort | racial and socioeconomic inequities in breast cancer screening before and during the covid-19 pandemic: analysis of two cohorts of women 50 years + |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8976168/ https://www.ncbi.nlm.nih.gov/pubmed/35366175 http://dx.doi.org/10.1007/s12282-022-01352-2 |
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