C0166 - The Effects of the COVID-19 Pandemic on Average-Risk Colorectal Cancer Screening: A Quality Assurance Evaluation to Assess Policy Success at the Facility Level

Judah Kreinbrook, BS¹, Sricharan Pusala, ², Gary Rabenold, MS³, Kelsey Berman, BS³, Phillip Foulis, MD, MPH⁴, Jason Colizzo, MD⁴, Wojciech Blonski, MD, PhD⁴, Ambuj Kumar, MD, MPH³, Jose Lezama, MD^4
1Tampa VA Clinical Research and Education Center, Tampa, FL; ²Tampa VA Clinical Research and Education Foundation, Tampa, FL; ³University of South Florida Morsani College of Medicine, Tampa, FL; ⁴James A. Haley VA Hospital, Tampa, FL

Introduction: While the Veterans’ Health Administration (VHA) leads the U.S. in colorectal cancer (CRC) screening, the COVID-19 pandemic required suspension of screening colonoscopies. In March 2020, national policy directed the triage of colonoscopies, suggesting average-risk patients undergo fecal immunochemical testing (FIT). Our facility began a mail-out FIT program due to this guidance. This project arose to assess the pandemic effects on screening while also assessing disparities across race/ethnicity.

Methods: Screening eligibility (lacking colonoscopy ≤10 years, FIT ≤ 12 months, +FIT ≤ 5 yrs.) on March 1, 2019, and 2020 formed pre-pandemic and pandemic cohorts, respectively. 45-75 y/o Black/African American & 50-75 y/o in all other races with a prior PCP visit ≤ 1 yr. were identified. ICD codes and VHA health factors prior to each eligibility date excluded those with family/personal history of CRC, irritable bowel disease, polyps, dementia, or previous palliative care. Area Deprivation Index (ADI) was obtained to characterize neighborhood-level disparities. Demographics, ICD/CPT codes, and PCP appointment records were queried from an administrative data warehouse. The unadjusted and adjusted association between pandemic/pre-pandemic CRC screening rates was assessed using binary logistic regression and summarized as odds ratio (OR) along with 95% confidence intervals (CI).

Results: The pandemic cohort attended significantly less PCP appts. (mean 1.56 vs. 2.56; p< 0.001) and was more likely to be younger (mean 61.9 vs. 62.9; p< 0.001), female (12.5% vs. 9.5%; p=0.002), married (54.9% vs. 50.6%; p=0.003) or ≥50% service-connected disability (81.5% vs. 71.3%; p< 0.001). In both, those screened were younger, female, in higher priority groups, attending more PCP appts., and lower in ADI. Pre-pandemic screening incidence was 50.3%, decreasing significantly to 15.1% in the pandemic (OR 0.17; 95% CI 0.15-0.20; p< 0.001), remaining statistically significant when adjusted for age, race, marital status, PCP Appts., and ADI (OR 0.16; 95% CI 0.15-0.19; P< 0.001)

Discussion: CRC screening uptake decreased significantly in the pandemic across race/ethnicity, suggesting no exacerbation of racial disparities. Nevertheless, the large decrease suggests that transition to mail-out FIT was insufficient to overcome pandemic effects in our opportunistic screening system. Additionally, lower ADI was correlated with lower screening uptake, demonstrating the need to incorporate ADI into health disparities assessments.




Disclosures:


Judah Kreinbrook, BS¹, Sricharan Pusala, ², Gary Rabenold, MS³, Kelsey Berman, BS³, Phillip Foulis, MD, MPH⁴, Jason Colizzo, MD⁴, Wojciech Blonski, MD, PhD⁴, Ambuj Kumar, MD, MPH³, Jose Lezama, MD⁴. C0166 - The Effects of the COVID-19 Pandemic on Average-Risk Colorectal Cancer Screening: A Quality Assurance Evaluation to Assess Policy Success at the Facility Level, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.