The COVID-19 Pandemic's Effect on Preventive Imaging

Introduction: This study assessed the effect of the COVID-19 pandemic on preventive care imaging and potential disparities because preventive care may be perceived as nonurgent. The objective was to identify the associations between the COVID-19 pandemic and changes in preventive imaging volumes for patients in general and as affected by race and ethnicities.

Methods: The authors performed a retrospective observational study by extracting the weekly volumes of all imaging studies between January 7, 2019 and May 1, 2022 from a radiology data warehouse at a tertiary care medical center (n=92,105 preventive imaging studies and 3,493,063 total radiology imaging studies) and compared preshutdown with postshutdown periods using a 2-sample t-test. Additional comparisons stratified by race and ethnicity were performed for mammograms and bone density examinations using interrupted time series models with negative binomial error distribution to assess the immediate level change and trends over time of preventive imaging volumes after shutdown.

Results: The authors found a significant decrease in bilateral mammograms, bone density examinations, and aortic ultrasound examinations in the postshutdown period compared with those in the preshutdown period (p<0.001, p=0.003, and p=0.001, respectively). There were no significant changes in low-dose computed tomography chest examinations (p=0.46). The shutdown was associated with a significant immediate decrease in mammograms in the Hispanic and Latino group to approximately three quarters of its preshutdown level (p=0.04). For bone density examinations, postshutdown weekly volumes tripled compared with the preshutdown volumes for Hispanic or Latino patients and doubled for non-Hispanic Black patients (p<0.0001 for both). In comparison, a significant decrease was seen for Other patients (reduced to nearly a fifth of preshutdown volume) (p<0.0001).

Conclusions: There was a significant decrease in overall volume of bilateral mammograms, bone density examinations, and aortic ultrasound examinations after pandemic shutdown. For mammograms, some of this decreasing trend was already seen before shutdown (such as for patients with Other race), so the shutdown was only specifically associated with an immediate decrease in mammogram levels in the Hispanic and Latino group. For bone density examinations, the shutdown was unexpectedly associated with an increase in volumes for Hispanic or Latino patients and non-Hispanic Black patients, which was countered by a significant steep decrease in volumes only for patients of Other race. Health systems should carefully explore their preventive screening examination volumes to determine which patients should be actively engaged to assure catch up on recommended care.