Preventive health screening rates have not returned to pre-pandemic levels

Key takeaways:

• Asian adults saw the greatest declines in wellness visits and most preventive screenings.
• A slower recovery in visits and screenings could worsen health care disparities, the researchers noted.

Rates of wellness visits and preventive health screenings remain below pre-COVID-19 pandemic levels, particularly among diverse groups, according to a recent study.

“Clinicians, health system leaders, and policymakers have raised concerns that persistent disruptions in health care access and preventive health screenings could have long-term public health consequences,” Christopher Alba, BS, a medical student at Harvard Medical School, and colleagues wrote in JAMA Health Forum. “However, little is known about whether health care access (eg, usual place for care, wellness visits) have returned to pre-pandemic levels in 2022.”

In a cross-sectional analysis, the researchers examined a population of 89,130 adults who participated in the National Health Interview Survey (NHIS) in 2021 and 2022.

They found that fewer participants had outpatient wellness visits within the past year in 2022 vs. 2019 (adjusted rate ratio [RR] = 0.98; 95% CI, 0.97-0.99), with the largest decline observed among Asian adults (aRR = 0.95; 95% CI, 0.92-0.98) compared with white adults.

Meanwhile, preventive screening rates for blood pressure (aRR = 0.95; 95% CI, 0.94-0.96), blood glucose (aRR = 0.95; 95% CI, 0.93-0.96) and cholesterol (aRR = 0.93; 95% CI, 0.92-0.94) were all lower in 2021 compared with 2019.

Adults were less likely to receive several cancer screenings in 2021 vs. 2019, which included:

• colorectal cancer screening (aRR = 0.88; 95% CI, 0.81-0.94);
• cervical cancer screening (aRR = 0.86; 95% CI, 0.83-0.89);
• breast cancer screening (aRR = 0.93; 95% CI, 0.9-0.97); and
• prostate cancer screening (aRR = 0.86; 95% CI, 0.78-0.94).

Alba and colleagues noted that although Asian adults had the greatest decline across many preventive screenings, Black and Hispanic adults had the largest declines in colorectal cancer screenings (aRR = 0.78; 95% CI, 0.67-0.91) and breast cancer screenings (aRR = 0.83; 95% CI, 0.75-0.91), respectively.

“Given that we found racial and ethnic minority populations received the fewest preventive screenings in 2019, a slower recovery from disruptions in these services during the pandemic may worsen health care disparities in future years,” they wrote.

The researchers also highlighted a few possible reasons for the continued declines in preventive screenings and wellness visits.

“First, fears of exposure to SARS-CoV-2 and other pathogens may have continued to deter people from attending in-person wellness visits through 2022,” they wrote. “Second, care deferrals during the start of the COVID-19 public health emergency may have resulted in increased demand for wellness visits, and thus reduced availability.”

The study was limited by the NHIS response rate, which ranged from 50% to 60% across both years.

Ultimately, the findings “highlight the urgent need for concerted health system, public health and health policy efforts to increase preventive screenings among eligible United States adults,” Alba and colleagues concluded.