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Showing content from https://pubmed.ncbi.nlm.nih.gov/35977205/ below:

Utilization of Women's Preventive Health Services During the COVID-19 Pandemic

. 2021 Jul 2;2(7):e211408. doi: 10.1001/jamahealthforum.2021.1408. eCollection 2021 Jul. Utilization of Women's Preventive Health Services During the COVID-19 Pandemic

Affiliations

¹ Division of General Medicine, University of Michigan Medical School, Ann Arbor.
² Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor.
³ Program on Women's Healthcare Effectiveness Research, University of Michigan Medical School, Ann Arbor.
⁴ Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor.
⁵ Editor, JAMA Health Forum.

PMID: 35977205
PMCID: PMC8796922
DOI: 10.1001/jamahealthforum.2021.1408

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Utilization of Women's Preventive Health Services During the COVID-19 Pandemic

Nora V Becker et al. JAMA Health Forum. 2021.

. 2021 Jul 2;2(7):e211408. doi: 10.1001/jamahealthforum.2021.1408. eCollection 2021 Jul. Affiliations

¹ Division of General Medicine, University of Michigan Medical School, Ann Arbor.
² Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor.
³ Program on Women's Healthcare Effectiveness Research, University of Michigan Medical School, Ann Arbor.
⁴ Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor.
⁵ Editor, JAMA Health Forum.

PMID: 35977205
PMCID: PMC8796922
DOI: 10.1001/jamahealthforum.2021.1408

Item in Clipboard

Abstract

Importance: The association of the COVID-19 pandemic with women's preventive health care use is unknown.

Objective: To describe utilization of women's preventive health services.

Design setting and participants: Cross-sectional study of women aged 18 to 74 years enrolled in a commercial health maintenance organization in Michigan.

Exposures: COVID-19 pandemic (2019-2020).

Main outcomes and measures: Adjusted odds ratios (AORs) of receiving breast cancer screening, cervical cancer screening, sexually transmitted infection (STI) screening, long-acting reversible contraception (LARC) insertions, and pharmacy-obtained contraception, adjusted for month, age, county, zip code characteristics (per-capita income, non-White percentage of population, non-English-proficient percentage of population), and plan designation (primary plan holder vs dependent).

Results: The study population included 685 373 women aged 18 to 74 years, enrolled for 13 000 715 person-months, of whom 10 061 275 person-months (77.4%) were among women aged 25 to 64 years and 8 020 215 (61.7%) were the primary plan holder, with mean zip code per capita income of $33 708, 20.2% mean zip code non-White population, and 3.4% mean zip code non-English-speaking population. For services requiring an in-person visit (breast cancer screening, cervical cancer screening, STI testing, and LARC insertions), utilization declined by 60% to 90% during the spring of 2020, with a nadir in April 2020, after which utilization for all services recovered to close to 2019 levels by July 2020. Claims for pharmacy-obtained hormonal contraceptives in 2020 were consistently 15% to 30% lower than 2019. The AORs of a woman receiving a given preventive service in 2020 compared with 2019 were significantly lower for breast cancer screening (AOR, 0.80; 95% CI, 0.79-0.80), cervical cancer screening (AOR, 0.80; 95% CI, 0.80-0.81), STI screening (AOR, 0.83; 95% CI, 0.82-0.84), LARC insertion (AOR, 0.87; 95% CI, 0.84-0.90), and pharmacy-obtained contraception (AOR, 0.73; 95% CI, 0.72-0.74) (all P < .001).

Conclusions and relevance: In this cross-sectional study of women enrolled in a large US commercial health maintenance organization plan, the COVID-19 pandemic was associated with large but transient declines in rates of breast cancer screening, cervical cancer screening, STI screening, and LARC insertions, and moderate persistent declines in pharmacy-obtained hormonal contraceptives. The overall odds of a woman receiving a given preventive service in 2020 was 20% to 30% lower than 2019. Further research into disparities in access to care and the health outcomes of decreased use of these key health services is warranted.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Moniz reported receiving grants from the Agency for Healthcare Research and Quality (grant No. K08 HS025465) and personal fees from the National Institute on Drug Abuse, RAND, and the Society of Family Planning outside the submitted work. Dr Tipirneni reported being supported by a K08 Clinical Scientist Development Award from the National Institute on Aging (K08 AG056591) and receiving speaker honoraria from the American Neurological Association and the Muribushi Project for Okinawa Residency Programs, all outside the submitted work. Dr Dalton reported being supported by the Agency for Healthcare Research and Quality (grant No. R01 HS023784) outside the submitted work, and receiving grants (National Institutes of Health, the American Association of Obstetricians and Gynecologists Foundation, the Laura and John Arnold Foundation, National Institute for Reproductive Health, the Michigan Department of Health and Human Services, and Blue Cross Blue Shield of Michigan Foundation) and personal fees (Bind, Merck, Society of Family Planning, Society of Maternal-Fetal Medicine, Medical Letter, and UpToDate) outside the submitted work. Dr Ayanian reported receiving grants from Blue Cross Blue Shield of Michigan Foundation outside the submitted work. No other disclosures were reported.

Figures
Figure 1.. Analytic Cohort Construction

Details of…

Figure 1.. Analytic Cohort Construction

Details of construction of analytic cohort and missing data. BCBSM…

Figure 1.. Analytic Cohort Construction

Details of construction of analytic cohort and missing data. BCBSM indicates Blue Cross Blue Shield of Michigan; HMO, health maintenance organization.

Figure 2.. Women’s Preventive Services Claim Rates…

Figure 2.. Women’s Preventive Services Claim Rates in 2019 and 2020

A and B, Monthly…

Figure 2.. Women’s Preventive Services Claim Rates in 2019 and 2020

A and B, Monthly rates of breast and cervical cancer screening. C, D, and E, Monthly rates of sexually transmitted infection (STI) testing, long-acting reversible contraception (LARC) insertions, and pharmacy-obtained contraception.