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

This cross-sectional study describes the utilization of women's preventive health services during the COVID-19 pandemic. Question How has utilization of preventive health services among commercially insured women changed during the COVID-19 pandemic? Findings In this cross-sectional study of 685 373 women enrolled in a large commercial health maintenance organization plan in Michigan, rates of breast cancer screening, cervical cancer screening, sexually transmitted infection screening, and prescriptions and new insertions for contraceptives all significantly declined in 2020 compared with 2019. For some services, there were small declines in utilization among women residing in zip codes that are lower income with higher proportions of non-White and non-English-speaking residents. Meaning The pandemic has disrupted the utilization of women's preventive health services and may be associated with increased disparities in access to these services. 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.

Automated summary

This cross-sectional study examined the utilization of women's preventive health services during the COVID-19 pandemic among commercially insured women. The study found significant declines in breast cancer screening, cervical cancer screening, sexually transmitted infection screening, and prescriptions for contraceptives in 2020 compared to 2019, with even larger declines in areas with lower income and higher proportions of non-White and non-English-speaking residents. The results suggest that the pandemic has disrupted access to women's preventive health services and led to increased disparities in utilization.