• Sunny Siddique, Rong Wang, Jacquelyne J Gaddy, Jessica M Stempel, Joshua L Warren, Cary P Gross, and Xiaomei Ma.
• Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, USA. sunny.siddique@yale.edu.
• J Gen Intern Med. 2024 Nov 4.

BackgroundColorectal cancer (CRC) screening is underutilized among those with lower socioeconomic status and in racial and ethnic minoritized populations who have been disproportionately impacted by COVID.ObjectiveTo compare disparities in CRC screening before and after the onset of the COVID pandemic among privately insured individuals.DesignRetrospective cohort study using deidentified claims data from the USA between January 1, 2017, and December 31, 2022.ParticipantsBlue Cross Blue Shield beneficiaries aged 50-75 years with average risk of CRC.Main Measure(S)Mean screening use was compared by demographic and area-level socioeconomic factors between the periods preceding (January 1, 2017 to February 28, 2020) and following (July 1, 2020 to December 31, 2022) the onset of the COVID pandemic. Difference-in-differences analysis was used to evaluate changes in screening differences.ResultsOur study included 21,724,223 beneficiaries. Compared to males, females had higher screening in both periods (p < 0.05), and this sex difference in screening increased 1.63% (95% confidence interval [CI]: 1.32%, 1.94%) following the onset of the pandemic. Compared to residents in areas with high socioeconomic status (SES), low SES area residents had lower screening (p < 0.001) during both periods. Furthermore, this difference grew 4.32% (95% CI, 3.76%, 4.88%) during the post-onset period. Metropolitan area residents had higher screening than non-metropolitan area residents during both periods (p < 0.001); however, this difference decreased 0.77% (95% CI, 0.34%, 1.20%) during the post-onset period. Among beneficiaries with high risk of CRC, the difference in screening based on social deprivation index and metropolitan area status increased 6.99% (95% CI, 5.77%, 8.20%) and 1.82% (95% CI, 0.88%, 2.74%), respectively.ConclusionsAmong privately insured individuals, CRC screening after the COVID pandemic recovered unevenly based on sex, area-level socioeconomic measures, and metropolitan area status, with pre-pandemic disparities persisting and even worsening for some of the factors.© 2024. The Author(s), under exclusive licence to Society of General Internal Medicine.

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