Racial Disparities in Endoscopy Cancellations During the COVID-19 Pandemic

• Published in: Digestive diseases and sciences 2023-03, Vol.68 (3), p.729-735
• Main Authors: Wang, Connie W., Mclean I, Richard, Cheng, Yao-Wen, Kim, Stephanie, Terdiman, Jonathan, Kathpalia, Priya, Beck, Kendall R.
• Format: Article
• Language: English
• Subjects: Adult; Analysis; Biochemistry; Coronaviruses; COVID-19; COVID-19 - epidemiology; COVID-19 diagnostic tests; COVID-19 Testing; Endoscopy; Gastroenterology; Hepatology; Humans; Logistics; Medicine; Medicine & Public Health; Oncology; Original; Original Article; Pandemics; Pandemics - prevention & control; Patients; Racial Groups; Transplant Surgery
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-022-07575-9

Introduction The coronavirus disease 19 (COVID-19) pandemic has disrupted healthcare delivery including elective endoscopy. We aimed to determine the prevalence of endoscopy cancellations in the COVID-19 era and identify patient characteristics associated with cancellation due to the pandemic. Methods Medical charts were reviewed for adults who cancelled an outpatient endoscopic procedure from 5/2020 to 8/2020. The association of patient characteristics with cancellation of endoscopy due to COVID-19 was assessed using logistic regression. Results There were 652 endoscopy cancelations with 211 (32%) due to COVID-19, 384 (59%) due to non-COVID reasons, and 57 (9%) undetermined. Among COVID-19 related cancellations, 75 (36%) were COVID-19 testing logistics related, 121 (57%) were COVID-19 fear related, and 15 (7%) were other. On adjusted analysis, the odds of cancellation due to COVID-19 was significantly higher for black patients (OR 2.04, 95% CI 1.07–3.88, p  = 0.03), while patients undergoing EGD (OR 0.56, 95% CI 0.31–0.99, p  = 0.05) or advanced endoscopy (OR 0.18, 95% CI 0.07–0.49, p  = 0.001) had lower odds of cancellation. The odds of cancelling due to COVID-19 testing logistics was significantly higher among black patients (OR 3.12, 95% CI 1.03–9.46, p  = 0.05) and patients with Medi-Cal insurance (OR 2.89, 95% CI 1.21–6.89, p  = 0.02). Conclusion Black race is associated with an increased risk of COVID-19 related cancellation. Specifically, black patients and those with Medi-Cal are at increased risk of cancellation related to logistics of obtaining pre-endoscopy COVID-19 testing. Racial and socioeconomic disparities in access to endoscopy may be further amplified by the COVID-19 pandemic and warrant further study.