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Dang JHT, Chen S, Hall S, Campbell JE, Chen MS, Doescher MP. Association Between COVID-19 and Planned and Postponed Cancer Screenings Among American Indian Adults Residing in California and Oklahoma, March-December 2020. Public Health Rep 2024:333549241254226. [PMID: 38832678 DOI: 10.1177/00333549241254226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024] Open
Abstract
OBJECTIVE Little is known about how the COVID-19 pandemic affected cancer screenings among American Indian people residing in California and Oklahoma, 2 states with the largest American Indian populations. We assessed rates and factors associated with cancer screenings among American Indian adults during the pandemic. METHODS From October 2020 through January 2021, we surveyed 767 American Indian adults residing in California and Oklahoma. We asked participants whether they had planned to obtain screenings for breast cancer, cervical cancer, and colorectal cancer (CRC) from March through December 2020 and whether screening was postponed because of COVID-19. We calculated adjusted odds ratios (AORs) for factors associated with reasons for planned and postponed cancer screening. RESULTS Among 395 participants eligible for breast cancer screening, 234 (59.2%) planned to obtain the screening, 127 (54.3%) of whom postponed it. Among 517 participants eligible for cervical cancer screening, 357 (69.1%) planned to obtain the screening, 115 (32.2%) of whom postponed it. Among 454 participants eligible for CRC screening, 282 (62.1%) planned to obtain CRC screening, 80 of whom (28.4%) postponed it. In multivariate analyses, women who lived with a child (vs did not) had lower odds of planning to obtain a breast cancer screening (AOR = 0.6; 95% CI, 0.3-1.0). Adherence to social distancing recommendations was associated with planning to have and postponement of cervical cancer screening (AOR = 7.3; 95% CI, 0.9-58.9). Participants who received (vs did not receive) social or financial support had higher odds of planning to have CRC screening (AOR = 2.0; 95% CI, 1.1-3.9). CONCLUSION The COVID-19 pandemic impeded completion of cancer screenings among American Indian adults. Interventions are needed to increase the intent to receive evidence-based cancer screenings among eligible American Indian adults.
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Affiliation(s)
- Julie H T Dang
- Department of Public Health Sciences, Division of Health Policy and Management, University of California, Davis School of Medicine, Sacramento, CA, USA
| | - Sixia Chen
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Spencer Hall
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Janis E Campbell
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Moon S Chen
- Department of Internal Medicine, Division of Hematology and Oncology, University of California, Davis School of Medicine, Sacramento, CA, USA
| | - Mark P Doescher
- Stephenson Cancer Center, College of Medicine, Department of Family and Preventive Medicine, University of Oklahoma College of Health Science Center, Oklahoma City, OK, USA
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Johnson KJ, O’Connell CP, Waken RJ, Barnes JM. Impact of COVID-19 pandemic on breast cancer screening in a large midwestern United States academic medical center. PLoS One 2024; 19:e0303280. [PMID: 38768115 PMCID: PMC11104587 DOI: 10.1371/journal.pone.0303280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 04/22/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Kimberly J. Johnson
- 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
| | - Caitlin P. O’Connell
- Brown School, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - R. J. Waken
- Division of Biostatistics, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Center for Advancing Health Services, Policy & Economics Research, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Justin M. Barnes
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, United States of America
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Martinez Leal I, Acquati C, Rogova A, Chen TA, Connors SK, Agrawal P, McNeill LH, Reitzel LR. Negotiating cancer alone: A qualitative study exploring care experiences of racially and ethnically diverse women diagnosed with breast cancer during COVID-19. J Health Psychol 2024; 29:367-381. [PMID: 38009435 PMCID: PMC11005304 DOI: 10.1177/13591053231214517] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2023] Open
Abstract
COVID-19 has critically impacted cancer care services including reduced screenings, diagnoses, and surgeries; particularly among Black and Latina/x women who already suffer worse outcomes. This qualitative study explored the care experiences of a diverse sample of breast cancer survivors (N = 21; 7 Black, 4 Hispanic, 10 White) undergoing treatment during the pandemic via online semi-structured interviews. Grounded theory analysis yielded the core category "negotiating cancer alone," that included: (1) psychological distress, negotiating the cancer trajectory in isolation; (2) provider/healthcare system diagnostic and treatment delays; (3) heightened anxiety about treatment delays causing cancer progression; (4) supportive care limitations; and (5) disparate experiences of cancer care disruptions. Black and Latina/x women described greater delays in care, financial challenges, treatment complications, and insurance limitations than White women. The study identifies cancer patients' pandemic-related psychological, healthcare system, and health equity challenges and suggests recommendations to support their increased psychological needs during oncologic care disruptions.
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Affiliation(s)
| | - Chiara Acquati
- University of Texas MD Anderson Cancer Center, USA
- University of Houston, USA
| | - Anastasia Rogova
- University of Texas MD Anderson Cancer Center, USA
- University of Houston, USA
| | | | | | | | | | - Lorraine R Reitzel
- University of Texas MD Anderson Cancer Center, USA
- University of Houston, USA
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Pleasant V. A Public Health Emergency: Breast Cancer Among Black Communities in the United States. Obstet Gynecol Clin North Am 2024; 51:69-103. [PMID: 38267132 DOI: 10.1016/j.ogc.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
While Black people have a similar incidence of breast cancer compared to White people, they have a 40% increased death rate. Black people are more likely to be diagnosed with aggressive subtypes such as triple-negative breast cancer. However, despite biological factors, systemic racism and social determinants of health create delays in care and barriers to treatment. While genetic testing holds incredible promise for Black people, uptake remains low and results may be challenging to interpret. There is a need for more robust, multidisciplinary, and antiracist interventions to reverse breast cancer-related racial disparities.
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Affiliation(s)
- Versha Pleasant
- Department of Obstetrics and Gynecology, Cancer Genetics & Breast Health Clinic, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
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Wilkerson AD, Gentle CK, Ortega C, Al-Hilli Z. Disparities in Breast Cancer Care-How Factors Related to Prevention, Diagnosis, and Treatment Drive Inequity. Healthcare (Basel) 2024; 12:462. [PMID: 38391837 PMCID: PMC10887556 DOI: 10.3390/healthcare12040462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/24/2024] Open
Abstract
Breast cancer survival has increased significantly over the last few decades due to more effective strategies for prevention and risk modification, advancements in imaging detection, screening, and multimodal treatment algorithms. However, many have observed disparities in benefits derived from such improvements across populations and demographic groups. This review summarizes published works that contextualize modern disparities in breast cancer prevention, diagnosis, and treatment and presents potential strategies for reducing disparities. We conducted searches for studies that directly investigated and/or reported disparities in breast cancer prevention, detection, or treatment. Demographic factors, social determinants of health, and inequitable healthcare delivery may impede the ability of individuals and communities to employ risk-mitigating behaviors and prevention strategies. The disparate access to quality screening and timely diagnosis experienced by various groups poses significant hurdles to optimal care and survival. Finally, barriers to access and inequitable healthcare delivery patterns reinforce inequitable application of standards of care. Cumulatively, these disparities underlie notable differences in the incidence, severity, and survival of breast cancers. Efforts toward mitigation will require collaborative approaches and partnerships between communities, governments, and healthcare organizations, which must be considered equal stakeholders in the fight for equity in breast cancer care and outcomes.
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Affiliation(s)
- Avia D Wilkerson
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Corey K Gentle
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Camila Ortega
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Zahraa Al-Hilli
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Breast Center, Integrated Surgical Institute, Cleveland Clinic, Cleveland, OH 44195, USA
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Duffy SW, de Jonge L, Duffy TE. Effects on Cancer Prevention from the COVID-19 Pandemic. Annu Rev Med 2024; 75:1-11. [PMID: 37625124 DOI: 10.1146/annurev-med-051022-122257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023]
Abstract
The COVID-19 pandemic led to disruption of health services around the world, including cancer services. We carried out a narrative review of the effect of the pandemic on cancer prevention services, including screening. Services were severely affected in the early months of the pandemic, and in some areas are still recovering. Large numbers of additional cancers or additional late-stage cancers have been predicted to arise over the coming years as a result of this disruption. To minimize the effects on cancer outcomes, it is necessary to return as quickly as possible to prepandemic levels of screening and prevention activity or indeed to exceed these levels. The recovery of services should address health inequalities.
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Affiliation(s)
- Stephen W Duffy
- Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom;
| | - Lucie de Jonge
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands;
| | - Thomas E Duffy
- Centre for Evaluation and Methods, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom;
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Oh J, Kim S, Lee M, Rhee SY, Kim MS, Shin JY, Lim H, Lee SW, Rahmati M, Kim S, Yon DK. National and regional trends in the prevalence of type 2 diabetes and associated risk factors among Korean adults, 2009-2021. Sci Rep 2023; 13:16727. [PMID: 37794087 PMCID: PMC10551027 DOI: 10.1038/s41598-023-43353-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/22/2023] [Indexed: 10/06/2023] Open
Abstract
Disproportionate impact of COVID-19 on socioeconomic and behavioral variables may have impacted the prevalence of diabetes. We utilized nationwide long-term serial study from the 2009 to 2021 Korea Community Health Survey (KCHS). We explored national and regional prevalence and trends of diabetes according to the socioeconomic and behavioral factors before and during the pandemic. Also, we interpreted which groups became more vulnerable to the prevalence of diagnosed diabetes during the pandemic. A total of 2,971,349 adults aged (19 to 39, 40 to 59, and ≥ 60 years) were included in the analysis. The prevalence of diagnosed diabetes increased slowly during the pandemic (11.6% [95% CI 11.5-11.7] in 2020 and 12.4% [95% CI 12.3-12.6] in 2021), compared to the pre-pandemic era (7.9% [95% CI 7.8-7.9] in 2009-2011 and 11.3% [95% CI 11.3-11.4] in 2018-2019). Also, women, low-income group, low-educational group, and infrequent walking group showed less prevalence of diagnosed diabetes than the others. The diabetic population increased slowly than expected during the pandemic. The pandemic seems to contribute to an unanticipated increase in under-diagnosis of diabetes among the already minority. This study may suggest reinforcing access to healthcare services among the minority during the pandemic.
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Affiliation(s)
- Jiyeon Oh
- Department of Medicine, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Soeun Kim
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Myeongcheol Lee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Sang Youl Rhee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, South Korea
| | - Min Seo Kim
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Hyunjung Lim
- Department of Medical Nutrition, Graduate School of East-West Medical Science, Kyung Hee University, Yongin, South Korea
| | - Seung Won Lee
- Department of Precision Medicine, Sungkyunkwan University School of Medicine, Suwon, South Korea
| | - Masoud Rahmati
- Department of Physical Education and Sport Sciences, Faculty of Literature and Human Sciences, Lorestan University, Khoramabad, Iran
- Department of Physical Education and Sport Sciences, Faculty of Literature and Humanities, Vali-e-Asr University of Rafsanjan, Rafsanjan, Iran
| | - Sunyoung Kim
- Department of Family Medicine, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, South Korea.
| | - Dong Keon Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea.
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea.
- Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, South Korea.
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Turpin R, Giorgi S, Curtis B. Pandemic distress associated with segregation and social stressors. Front Public Health 2023; 11:1092269. [PMID: 37033081 PMCID: PMC10080044 DOI: 10.3389/fpubh.2023.1092269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/03/2023] [Indexed: 04/11/2023] Open
Abstract
Background Racial/ethnic minorities are disproportionately impacted by the COVID-19 pandemic, as they are more likely to experience structural and interpersonal racial discrimination, and thus social marginalization. Based on this, we tested for associations between pandemic distress outcomes and four exposures: racial segregation, coronavirus-related racial bias, social status, and social support. Methods Data were collected as part of a larger longitudinal national study on mental health during the pandemic (n = 1,309). We tested if county-level segregation and individual-level social status, social support, and coronavirus racial bias were associated with pandemic distress using cumulative ordinal regression models, both unadjusted and adjusted for covariates (gender, age, education, and income). Results Both the segregation index (PR = 1.19; 95% CI 1.03, 1.36) and the coronavirus racial bias scale (PR = 1.17; 95% CI 1.06, 1.29) were significantly associated with pandemic distress. Estimates were similar, after adjusting for covariates, for both segregation (aPR = 1.15; 95% CI 1.01, 1.31) and coronavirus racial bias (PR = 1.12; 95% CI 1.02, 1.24). Higher social status (aPR = 0.74; 95% CI 0.64, 0.86) and social support (aPR = 0.81; 95% CI 0.73, 0.90) were associated with lower pandemic distress after adjustment. Conclusion Segregation and coronavirus racial bias are relevant pandemic stressors, and thus have implications for minority health. Future research exploring potential mechanisms of this relationship, including specific forms of racial discrimination related to pandemic distress and implications for social justice efforts, are recommended.
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Affiliation(s)
- Rodman Turpin
- Department of Global and Community Health, College of Public Health, George Mason University, Fairfax, VA, United States
- *Correspondence: Rodman Turpin, ; Brenda Curtis,
| | - Salvatore Giorgi
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, United States
| | - Brenda Curtis
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, United States
- *Correspondence: Rodman Turpin, ; Brenda Curtis,
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