Brown School, Washington University in St. Louis, St. Louis, Missouri, United States of America.
Siteman Cancer Center, Washington University in St Louis, St. Louis, Missouri, United States of America.
PLoS One. 2024 May 20;19(5):e0303280. doi: 10.1371/journal.pone.0303280. eCollection 2024.
Access to breast screening mammogram services decreased during the COVID-19 pandemic. Our objectives were to estimate: 1) the COVID-19 affected period, 2) the proportion of pandemic-associated missed or delayed screening encounters, and 3) pandemic-associated patient attrition in screening encounters overall and by sociodemographic subgroup.
We included screening mammogram encounter EPIC data from 1-1-2019 to 12-31-2022 for females ≥40 years old. We used Bayesian State Space models to describe weekly screening mammogram counts, modeling an interruption that phased in and out between 3-1-2020 and 9-1-2020. We used the posterior predictive distribution to model differences between a predicted, uninterrupted process and the observed screening mammogram counts. We estimated associations between race/ethnicity and age group and return screening mammogram encounters during the pandemic among those with 2019 encounters using logistic regression.
Our analysis modeling weekly screening mammogram counts included 231,385 encounters (n = 127,621 women). Model-estimated screening mammograms dropped by >98% between 03-15-2020 and 05-24-2020 followed by a return to pre-pandemic levels or higher with similar results by race/ethnicity and age group. Among 79,257 women, non-Hispanic (NH) Asians, NH Blacks, and Hispanics had significantly (p < .05) lower odds of screening encounter returns during 2020-2022 vs. NH Whites with odds ratios (ORs) from 0.70 to 0.91. Among 79,983 women, those 60-69 had significantly higher odds of any return screening encounter during 2020-2022 (OR = 1.28), while those ≥80 and 40-49 had significantly lower odds (ORs 0.77, 0.45) than those 50-59 years old. A sensitivity analysis suggested a possible pre-existing pattern.
These data suggest a short-term pandemic effect on screening mammograms of ~2 months with no evidence of disparities. However, we observed racial/ethnic disparities in screening mammogram returns during the pandemic that may be at least partially pre-existing. These results may inform future pandemic planning and continued efforts to eliminate mammogram screening disparities.
在 COVID-19 大流行期间，获得乳房筛查乳房 X 光检查服务的机会减少了。我们的目标是估计：1）COVID-19 影响期，2）与大流行相关的错过或延迟筛查的比例，以及 3）筛查总体和按社会人口统计学亚组的与大流行相关的患者流失。
我们纳入了 2019 年 1 月 1 日至 2022 年 12 月 31 日期间年龄≥40 岁女性的筛查乳房 X 光检查 EPIC 数据。我们使用贝叶斯状态空间模型描述每周筛查乳房 X 光检查计数，对 2020 年 3 月 1 日至 9 月 1 日之间逐步进行和退出的中断进行建模。我们使用后验预测分布来模拟预测、不间断的过程与观察到的筛查乳房 X 光检查计数之间的差异。我们使用逻辑回归估计了种族/族裔和年龄组之间的关联，以及在 2019 年接触人群中，在大流行期间与 2020-2022 年期间返回筛查乳房 X 光检查的关联性。
我们对每周筛查乳房 X 光检查计数进行建模的分析包括 231,385 次检查（n = 127,621 名女性）。03-15-2020 至 05-24-2020 期间，模型估计的乳房 X 光检查次数下降了>98%，随后恢复到大流行前水平或更高水平，按种族/族裔和年龄组的结果相似。在 79,257 名女性中，非西班牙裔（NH）亚裔、NH 黑人、和西班牙裔的筛查接触返回的可能性显著降低（p <.05），与 NH 白人相比，比值比（ORs）为 0.70 至 0.91。在 79,983 名女性中，60-69 岁的女性在 2020-2022 年期间任何返回筛查的可能性明显更高（OR = 1.28），而 80 岁及以上和 40-49 岁的女性返回筛查的可能性明显更低（ORs 0.77，0.45）比 50-59 岁的女性。敏感性分析表明可能存在预先存在的模式。
这些数据表明，筛查乳房 X 光检查的短期大流行影响约为 2 个月，没有证据表明存在差异。然而，我们在大流行期间观察到了筛查乳房 X 光检查返回的种族/族裔差异，这些差异可能至少部分是预先存在的。这些结果可能为未来的大流行规划和消除乳房 X 光检查筛查差异的持续努力提供信息。
