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Implications for health system resilience: Quantifying the impact of the COVID-19-related stay at home orders on cancer screenings and diagnoses in southeastern North Carolina, USA.

ABSTRACT: COVID-19 impacted hospital systems across the globe. Focus shifted to responding to increased healthcare demand while mitigating COVID-19 spread on their campuses. Mitigation efforts limited medical professional-patient interactions, including patient access to preventive cancer screenings. Data were gleaned from a health information exchange containing records on over 2 million patients in southeastern North Carolina, USA. This study tested five hypotheses: H₁: Weekly cancer screenings significantly decreased during North Carolina's (NC) Stay-At-Home (SAH) orders; H₂: Weekly cancer diagnoses significantly decreased during NC's SAH orders; H₃: Weekly cancer screenings significantly increased after the end of NC's SAH orders; H₄: Weekly cancer diagnoses significantly increased after the end of NC's SAH orders; and H₅: Weekly advanced cancer diagnoses significantly increased after the end of NC's SAH orders. Time series regression analysis was employed to quantify trends. Results suggested strong support of H₁ and H₃, moderate support of H₄, mixed support of H₅, and no support of H₂. For example, compared to before the SAH orders, we estimated 662.3 fewer weekly breast cancer screenings during the SAH orders (H₁). After the SAH orders (H₃), we estimated 232.5 more breast cancer screenings and 10.6 more breast cancer diagnoses. This work quantifies the impact of COVID-19 associated SAH orders on cancer screenings and diagnoses and suggests the potential for delayed or missed cancer diagnoses. This evident disruption in providing routine medical care also highlights the importance of strengthening health systems (or organizations) and improving resilience to natural disasters and infectious disease outbreaks.

SUBMITTER: Carroll R

PROVIDER: S-EPMC8926435 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Previous evidence has identified potential racial disparities in access to community water and sewer service in peri-urban areas adjacent to North Carolina municipalities. We performed the first quantitative, multi-county analysis of these disparities. Using publicly available data, we identified areas bordering municipalities and lacking community water and/or sewer service in 75 North Carolina counties. Logistic regression was performed to evaluate the relationship between race and access to service in peri-urban areas, controlling for population density, median home value, urban status, and percent white in the adjacent municipality. In the peri-urban areas analyzed, 67% of the population lacked community sewer service, and 33% lacked community water service. In areas other than those with no black residents, odds of having community water service (p<0.01) or at least one of the two services (p<0.05) were highest for census blocks with a small proportion of black residents and lowest in 100% black census blocks, though this trend did not hold for access to community sewer service alone. For example, odds of community water service were 85% higher in areas that were greater than 0% but less than 22% black than in 100% black areas (p<0.001). Peri-urban census blocks without black populations had the lowest odds of community water service, community sewer service, and at least one of the two services, but this difference was only statistically significant for sewer. Peri-urban areas lacking service with no black residents were wealthier than 100% black areas and areas with any percent black greater than 0%. Findings suggest two unserved groups of differing racial and socioeconomic status: (1) lower-income black populations potentially excluded from municipal services during the era of legal racial segregation and (2) higher-income non-black populations. Findings also suggest greater racial disparities in community water than community sewer services statewide.

Dataset Information

Implications for health system resilience: Quantifying the impact of the COVID-19-related stay at home orders on cancer screenings and diagnoses in southeastern North Carolina, USA.

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