Racial and Ethnic Disparities in Screening Mammography During COVID-19 in the Upper Midwest

Objective: Studies conducted prior to COVID-19 suggested that racial and ethnic disparities in mammographic screening have reduced over time. COVID-19 has had devastating effects on racial and ethnic minority populations, resulting in delays in preventive screening. Our purpose was to determine if racial and ethnic minority groups were less likely to receive mammographic screening during the COVID-19 pandemic. Methods: Retrospective cross-sectional study was conducted in a multisite academic medical center in the Upper Midwest to evaluate screening disparities during the COVID-19 pandemic. Participants included 50- to 74-year-old female individuals (June 2021 to May 2022). Additional control group was included for pre-COVID-19 case-control comparison (June 2018 to May 2019). Unadjusted and adjusted logistic regression analyses estimated the association between screening and race and ethnicity including interaction terms to assess temporal interactions associated with COVID-19. Study was deemed exempt from institutional review board review. Results: In all, 37,509 eligible female patients were included. Of them, 73.8% of eligible patients received a mammogram within the last 2 years (White 74.7%, Black 57.6%, Asian 67.0%, American Indian 60.1%, Hispanic 64.2%). In our adjusted analyses, Black (P < .001), Asian (P = .003), and American Indian patients (P = .001) were less likely to receive screening. Hispanic patients were comparably likely to receive screening (P = .338). Non-English-preferred languages, uninsured or Medicaid, and living in rural areas were associated with decreased screening (P < .001). In all, 36,768 eligible female patients were included for pre-COVID-19 comparison. Compared with the pre-COVID- 19 time period, COVID-19 was associated with increased screening disparities (P < .001) for Black and Hispanic women (P < .001). Conclusion: The COVID-19 pandemic was associated with increased racial and ethnic screening disparities. Targeted outreach efforts are required to ensure equitable access to mammographic screening for medically underserved patient populations.