Screenings for all adults, especially racial and ethnic minorities, lag pre-pandemic levels: study

Screenings for diseases such as heart failure and cancer had not returned to pre-pandemic levels by 2022, and that could present a huge challenge in the coming years, a challenge that may be more acute among racial and ethnic minorities, according to a study in JAMA Health Forum.

“Asian adults experienced the largest relative decreases across most preventive screenings, while Black and Hispanic adults experienced large declines in colorectal cancer screening … and breast cancer screening, respectively,” the study found.

Researchers with Beth Israel Deaconess Medical Center compared healthcare access and rates of preventive health screenings among eligible adults in the U.S. in 2021 and 2022 to the pre-pandemic year of 2019. They examined data from 89,130 adults collected by the National Health Interview Survey (NHIS).

“Heart disease and cancer are leading causes of death in the U.S., and persistently lower rates of screenings for cardiovascular risk factors and cancer could have potentially devastating consequences for morbidity and mortality long term, particularly in light of rising cardiometabolic disease rates in young adults,” according to the study.

Fewer people had wellness visits in 2022 compared with 2019, with the most pronounced decline seen among Asian Americans. In addition, adults were more likely to delay getting care or not receiving care at all in 2022 compared to 2019 because of cost.

Blood pressure, blood glucose and cholesterol screenings in 2021 remained below 2019 levels. That was also true for colorectal cancer screening, cervical cancer screening, breast cancer screening and prostate cancer screening.  

“Differences in preventive screening rates across years persisted after additional adjustment for socioeconomic factors (income, employment status, and insurance coverage),” the study said.

The researchers note that they were initially concerned that the decreases in preventive health screenings might have been driven by loss of insurance coverage, unemployment or other economic loss. However, those changes continued even after they adjusted for those factors.

“Moreover, our results suggest that financial barriers to receiving medical care decreased in 2021 and 2022 compared with 2019,” the researchers wrote. “This is consistent with our finding that income levels and health insurance coverage remained stable during the pandemic despite increases in unemployment likely due to state and federal efforts to bolster safety-net services (e.g., Medicaid enrollment, supplemental income) as part of the COVID-19 public health emergency.”

The researchers note that between 8 million and 24 million individuals might lose Medicaid coverage by May as states cull roles as a result of the drawback of funding allocated because of the COVID-19 public health emergency.

“Given that Black and Hispanic adults, as well as some Asian subgroups, are more likely to receive coverage through Medicaid compared with White adults, loss of Medicaid coverage may exacerbate declines in wellness visits and preventive screenings in future years,” according to the study. “Policy strategies to mitigate loss of Medicaid coverage are needed and should be paired with efforts to launch and scale up culturally tailored, national quality improvement programs that use patient reminders, media campaigns, at-home tests, and community health center networks.”

The decline in screenings for Asian Americans raises unique concerns, according to the study. They experienced the most pronounced declines in cardiovascular risk factor screenings and many cancer screenings.

“This is concerning given that studies identified lower baseline rates of screenings among the overall Asian adult population and specific Asian subpopulations (ie, Chinese, Filipino, Indian, Korean, and Vietnamese adults) prior to the COVID-19 pandemic,” the study said. “Suggested explanations for these patterns have included the implications of diverse languages and dialects, stigmatized cultural perceptions of cancer, and use of complementary medicine. Furthermore, while medical financial concerns decreased in 2021 and 2022 for most racial and ethnic subpopulations, such concerns were similar across years for Asian adults.”

Researchers note some of the limitations of their study that included a 50% to 60% response rate to the NHIS over the years.

In addition, the data are self-reported, making them subject to recall bias. In addition, the researchers state that “we were unable to further stratify the study group by race and ethnicity beyond the options predefined by the NHIS. Heterogeneity exists within each of the studied racial and ethnic subpopulations and additional research should be conducted to identify potential differences in preventive screening within these subpopulations to properly direct resources and tailor interventions.”