Missed Vaccines, Skipped Colonoscopies: Preventive Care Plummets

When the coronavirus pandemic hit, Americans vastly scaled back their preventive health care, and there is little sign that this deferred care will be made up.

Vaccinations dropped by nearly 60 percent in April, and almost no one was getting a colonoscopy, according to new data from the nonprofit Health Care Cost Institute.

The data, drawn from millions of health insurance claims, shows a consistent pattern, whether it was prostate screenings or contraceptives: Preventive care declined drastically this spring and, as of late June, had not yet recovered to normal levels. Many types of such care were still down by a third at the start of this summer, the most recent data available shows, as Americans remained wary of visiting hospitals and medical offices.

“The thing that jumped out at me was how similar all the patterns were,” said Niall Brennan, the institute’s president. “The bottom was deeper for some services than others, but the slope of the lines was pretty similar no matter what service you picked.”

Americans continued seeking care they couldn’t avoid — hospital admissions for childbirth, for example, held steady — but avoided care they could put off. More invasive preventive procedures, such as mammograms and colonoscopies, showed the greatest decline.

Colonoscopies, which are generally used to screen for colon cancer, declined by 88 percent in mid-April and were still 33 percent lower than normal at the end of June. Mammograms, which fell 77 percent at the height of the pandemic, are still down 23 percent.

The numbers could change slightly as insurers continue to process health providers’ claims. A small time lag probably explains why the data currently shows births declining in June. As more data becomes available, preventive services may show stronger recent increases.

The data shows how the pandemic has rippled outward from the intensive care units that have cared for coronavirus patients to primary care doctors and pediatricians, who have seen their practices upended by patients’ reduced demand.

Critical childhood vaccinations for hepatitis, measles, whooping cough and other diseases also declined significantly, a trend that had already begun to worry pediatricians earlier in the pandemic. Of particular concern, measles vaccinations fell 73 percent in mid-April and were still down 36 percent at the end of June.

Measles was already on the rise in the United States before this year, coinciding with the growing strength of the anti-vaccination movement. The fact that fewer children have been vaccinated because of coronavirus fears could worsen the trend.

But one preventive service stayed relatively steady through the pandemic: pregnancy-related ultrasounds. Those declined slightly in March and April but never fell more than 20 percent below 2019 levels. Insertions of IUDs, one of the most effective birth control methods, declined like other preventive care — raising the possibility of an increase in pregnancies in coming months.

When the pandemic began, some experts predicted that a decline in care would be followed by a boom in demand. Doctor’s offices might see higher-than-normal visit numbers as patients made up for deferred care.

Six months into the pandemic, that hasn’t happened. Doctor visits appear to be inching toward normal levels but not exceeding volumes seen in recent years. Even if demand does increase in coming months, health providers may have difficulty meeting it, as social distancing protocols limit their capacity.

“The pandemic has not played out like any of us would have hoped, and we don’t see that pattern,” said Ateev Mehrotra, associate professor of health policy at Harvard Medical School. “Now it seems that the vast majority of that deferred care will never come back.”

Dr. Mehrotra has recently studied trends in doctor office visits using a different data set, and his work also shows a significant drop-off in doctor visits, followed by an incomplete rebound through mid-August.

While doctor visits for adults are much closer to normal numbers, those for children were still 26 percent lower than normal as of a month ago.

Health researchers say it will take years to understand how the deferred preventive care might affect health outcomes for Americans. Will fewer colonoscopies, for example, translate into more cases of advanced colon cancer? Will there be more outbreaks of communicable diseases because of lower vaccination rates?

“Some of these are time-sensitive services,” said Eric Schneider, senior vice president for research at the Commonwealth Fund. “Are we going to see a little baby boomlet because women were unable to get family planning services? These are services where you’d want to see a rebound above the baseline, to get a sense the backlog was clearing. We don’t see that, and it’s a concern.”

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