Article Figures & Data
Figures
- Figure 1.
The monthly volume of breast cancer screenings in the study cohort (N = 1,186,669) before and after onset of the COVID-19 pandemic, January 2017 through February 2022.
Tables
Characteristic Patients, No. (%)
(N = 1,186,669)Age groupa 40-49 years 358,926 (30.2) 50-64 years 651,740 (54.9) ≥65 years 176,003 (14.8) Race and ethnicity Non-Hispanic White 596,584 (50.3) Non-Hispanic Black 152,816 (12.9) Non-Hispanic other 21,732 (1.8) Hispanic 85,060 (7.2) Unknown 330,477 (27.8) Marital status Married 263,703 (22.2) Single 201,456 (17.0) Unknown 721,510 (60.8) Regional location Northeast 489,763 (41.3) South 367,073 (30.9) Midwest 216,939 (18.3) West 112,894 (9.5) Comorbidities Ischemic heart disease 18,260 (1.5) Heart failure 8,216 (0.7) Depression 82,227 (6.9) Cerebrovascular disease 12,937 (1.1) Diabetes 90,225 (7.6) Osteoporosis 29,428 (2.5) Hypothyroidism 78,094 (6.6) Hypertension 212,097 (17.9) Hyperlipidemia 170,074 (14.3) Renal failure 29,721 (2.5) COPD 23,700 (2.0) Atrial fibrillation/atrial flutter 12,164 (1.0) Health care service visits Mental health visits 0 970,611 (81.8) 1-2 126,838 (10.7) ≥3 89,220 (7.5) Preventive care visits 0 935,806 (78.9) 1 149,265 (12.6) ≥2 101,598 (8.6) Cervical cancer screening visits 0 1,075,761 (90.7) ≥1 110,908 (9.3) COPD = chronic obstructive pulmonary disease.
↵a Mean (SD) age was 54.8 (8.2) years.
- Table 2.
Comparison of the Breast Cancer Screening Follow-up Rate Between the Pre-COVID Period and the COVID Period
Group Follow-up Screening Rate,a % (95% CI) Difference, % (95% CI) Pre-COVID Periodb COVID Periodc Total 78.9 (78.8 to 79.0) 77.7 (77.6 to 77.8) −1.2d (−1.3 to −1.0) Age group 40-49 years 73.9 (73.7 to 74.2) 74.0 (73.7 to 74.2) 0.1 (−0.3 to 0.4) 50-64 years 79.7 (79.5 to 79.9) 77.9 (77.6 to 78.0) −1.9d (−2.1 to −1.6) ≥65 years 83.6 (83.3 to 83.8) 80.3 (80.1 to 80.5) −3.2d (−3.6 to −2.9) Race and ethnicity Non-Hispanic White 81.2 (81.0 to 81.3) 80.3 (80.2 to 80.5) −0.8d (−1.0 to −0.6) Non-Hispanic Black 76.8 (76.4 to 77.1) 76.3 (76.0 to 76.6) −0.4 (−0.9 to 0.0) Non-Hispanic othere 79.2 (78.3 to 80.1) 74.8 (74.0 to 75.6) −4.5d (−5.7 to −3.2) Hispanic 70.8 (70.3 to 71.3) 70.3 (69.8 to 70.7) −0.5 (−1.2 to 0.2) Unknown 77.4 (77.2 to 77.7) 74.9 (74.7 to 75.1) −2.5d (−2.8 to −2.2) Marital status Married 78.8 (78.5 to 79.0) 76.5 (76.3 to 76.7) −2.3d (−2.6 to −2.0) Single 76.2 (75.9 to 76.5) 75.1 (74.8 to 75.3) −1.1d (−1.5 to −0.7) Unknown 79.8 (79.6 to 79.9) 78.8 (78.7 to 79.0) −0.9d (−1.1 to −0.7) Regional location Northeast 80.9 (80.7 to 81.1) 79.3 (79.2 to 79.5) −1.6d (−1.8 to −1.4) South 77.3 (77.0 to 77.5) 76.0 (75.8 to 76.2) −1.3d (−1.6 to 1.0) Midwest 80.5 (80.3 to 80.7) 80.5 (80.3 to 80.7) 0.0 (−0.3 to 0.3) West 70.6 (70.2 to 71.1) 67.8 (67.4 to 68.2) −2.9d (−3.5 to −2.2) ↵a Follow-up screening rate is defined as the percentage of women who received a follow-up breast cancer screening within 24 months of their previous (index) screening.
↵b If a woman was screened during 2017, her follow-up screening was due before 2020, which was considered to be the pre-COVID period.
↵c If a woman was screened between March 1, 2019 and February 28, 2020, her follow-up screening was due between March 1, 2020 and February 28, 2022, which was considered to be the COVID period.
↵d P <.01.
↵e Asian, American Indian or Alaska Native, and Native Hawaiian or Other Pacific Islander.
- Table 3.
Adjusted Odds Ratios and Average Marginal Effects for Follow-up Breast Cancer Screening
Measure Adjusted Odds Ratio (95% CI) Average Marginal Effect, % (95% CI) Period Pre-COVID (ref) … … COVID 0.86 (0.86 to 0.87) −2.5 (−2.6 to −2.3) Age group 40-49 years (ref) … … 50-64 years 1.28 (1.26 to 1.29) 4.1 (3.9 to 4.3) ≥65 years 1.54 (1.52 to 1.56) 7.3 (7.0 to 7.6) Race and ethnicity Non-Hispanic White (ref) … … Non-Hispanic Black 0.84 (0.82 to 0.85) −3.0 (−3.3 to −2.7) Non-Hispanic othera 0.82 (0.79 to 0.85) −3.4 (−4.0 to −2.8) Hispanic 0.69 (0.68 to 0.71) −6.2 (−6.6 to −5.9) Unknown 0.68 (0.67 to 0.69) −6.5 (−6.7 to −6.3) Marital status Married (ref) … … Single 0.97 (0.95 to 0.98) −0.6 (−0.8 to −0.3) Unknown 1.07 (1.06 to 1.09) 1.2 (1.0 to 1.4) Regional location Northeast (ref) … … South 0.77 (0.76 to 0.79) −4.3 (−4.6 to −4.1) Midwest 0.82 (0.80 to 0.83) −3.4 (−3.7 to −3.1) West 0.50 (0.49 to 0.51) −11.7 (−12.0 to −11.3) Comorbiditiesb Ischemic heart disease 0.88 (0.85 to 0.90) −2.2 (−2.7 to −1.8) Heart failure 0.86 (0.82 to 0.90) −2.6 (−3.3 to −1.9) Depression 0.94 (0.92 to 0.96) −1.1 (−1.4 to −0.8) Cerebrovascular disease 0.92 (0.89 to 0.95) −1.4 (−1.9 to −0.8) Diabetes 0.93 (0.91 to 0.94) −1.2 (−1.5 to 1.0) Osteoporosis 1.36 (1.32 to 1.40) 5.2 (4.7 to 5.7) Hypothyroidism 1.05 (1.04 to 1.07) 0.9 (0.6 to 1.2) Hypertension 1.05 (1.04 to 1.07) 0.9 (0.6 to 1.1) Hyperlipidemia 1.30 (1.28 to 1.32) 4.5 (4.2 to 4.7) Renal failure 0.82 (0.80 to 0.84) −3.3 (−3.8 to −2.9) COPD 0.79 (0.77 to 0.81) −4.0 (−4.5 to −3.5) Atrial fibrillation/atrial flutter 0.99 (0.95 to 1.03) −0.1 (−0.8 to 0.5) Health care service visits Mental health visits (ref = 0) 1-2 0.85 (0.84 to 0.86) −2.8 (−3.0 to −2.6) ≥3 0.90 (0.88 to 0.92) −1.8 (−2.1 to −1.4) Preventive care visits (ref = 0) 1 1.20 (1.18 to 1.21) 3.1 (2.9 to 3.2) ≥2 1.84 (1.81 to 1.87) 10.3 (10.0 to 10.6) Cervical cancer screening visits (ref = 0) ≥1 1.26 (1.24 to 1.28) 3.9 (3.6 to 4.1) COPD = chronic obstructive pulmonary disease; ref = reference group.
↵a Asian, American Indian or Alaska Native, and Native Hawaiian or Other Pacific Islander.
↵b Reference group for each is those without the comorbidity.
Note: From the logistic regression model, using the generalized estimating equations method with an exchangeable working correlation structure (N = 761,508 individuals, N = 1,076,676 observations).
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