Elicit: COVID-19 and Racial Health Disparities (public)
COVID-19 and Racial Health Disparities
How did the COVID-19 pandemic impact racial and ethnic disparities in specific preventive health services, such as cancer screenings, vaccinations, and routine health check-ups?
The COVID-19 pandemic amplified racial and ethnic disparities in preventive health services, as minority groups had greater declines in cancer screenings, childhood immunizations, and routine visits, with delayed recovery compared to White populations.
Abstract
The COVID-19 pandemic coincided with marked declines in preventive health services that varied by racial and ethnic group. Studies report that cancer screenings dropped across all groups. For example, one analysis found that mammography rates among Asians fell 12.3 percentage points relative to Whites. In a large cohort, mammography screening during the pandemic was documented at 74.7% for Whites, 57.6% for Blacks, 67.0% for Asian/Pacific Islanders, 60.1% for American Indians, and 64.2% for Hispanic patients. Cervical screening declined by 39.3% among Hispanic patients between 2019 and 2020 compared with a 21.2% drop for non-Hispanic Whites, with subsequent partial rebounds noted. Other studies noted declines in colon cancer screening—for instance, colonoscopy rates decreased by 49% for Whites and 55% for African Americans in one analysis, although a rise in stool-based testing was reported for some groups.
Disparities in vaccination services also emerged. Several studies found that childhood immunization rates among non-Hispanic Black children remained the lowest and that rates among Asian and Hispanic children stayed below 2019 levels. Similar patterns were observed for routine care: well visits were 7.45 percentage points lower among Asians than Whites, and data on Medicare Annual Wellness Visits indicated persistent gaps for non-white and Hispanic populations.
Recovery patterns differed by group. While some studies reported a robust rebound in screening for White and Black patients, Hispanic, Asian, American Indian/Alaska Native, and Native Hawaiian groups were more likely to experience delayed or incomplete recovery. These findings, expressed in quantitative differences and recovery trajectories, directly document that the pandemic increased disparities in preventive health services among racial and ethnic groups.
Methods
We analyzed 40 sources from an initial pool of 999, using 7 screening criteria. Each paper was reviewed for 5 key aspects that mattered most to the research question.
Results
Characteristics of Included Studies
| Study | Study Design | Population/Setting | Preventive Services Examined | Racial/Ethnic Groups Analyzed |
|---|---|---|---|---|
| Dubay et al., 2024 | Database analysis; Observational study (retrospective) using secondary survey data | National Health Interview Survey survey data | Six preventive services (including mammograms) | White, Asian, Hispanic, American Indian/Alaska Native |
| Milton et al., 2023 | Retrospective cohort study using electronic medical records | Multi-location academic medical center in the Midwest | Breast cancer screening (mammography) | White, Black/African American, Hispanic/Latino, Asian/Native Hawaiian/Other Pacific Islander, American Indian/Alaska Native |
| Foster et al., 2025 | Retrospective cross-sectional study with case-control comparison | Multisite academic medical center in the Upper Midwest | Mammographic screening | White, Black, Asian, American Indian, Hispanic |
| McGrath et al., 2024 | Interrupted time series analysis of electronic health record data | Federally Qualified Health Centers electronic health records, nationwide | Cancer screenings, blood pressure control, diabetes control, childhood immunizations | Asian, Black/African American, Hispanic/Latino, Native Hawaiian/Other Pacific Islander, American Indian/Alaska Native |
| Nguyen et al., 2024 | Cross-sectional study using database analysis of electronic health record data | All of Us Research Program | Cervical cancer screening | Non-Hispanic White, Hispanic |
| Star et al., 2023a | Cross-sectional study using National Health Interview Survey data | 2019 and 2021 National Health Interview Survey | Breast, cervical, prostate, colorectal cancer screening | Non-Hispanic Asian, Non-Hispanic Black, Hispanic |
| Tsui et al., 2023 | Retrospective database analysis using interrupted time series | Optum Clinformatics Data Mart; nationwide | Breast cancer screening | Non-Hispanic White, Asian, others (not clearly specified) |
| Sprague et al., 2021 | Retrospective observational study using database analysis and interrupted time series | Breast Cancer Surveillance Consortium (62 radiology facilities) | Screening and diagnostic mammography | Black, White, Hispanic, Asian |
| Fasano et al., 2021 | Retrospective interrupted time series analysis | Healthcare system in New York City | Breast cancer screening (mammography) | White American, African American, Asian, Hispanic/Latina |
| Sprague et al., “OP-JNCI210046” | Database analysis with observational and time-series elements | Breast Cancer Surveillance Consortium | Screening and diagnostic mammography | Black, White, Hispanic, Asian |
Key Insights
- Declines in cancer screening during the pandemic were reported for all racial/ethnic groups, but the magnitude of decline and the pattern of recovery varied.
- Hispanic, Asian, and American Indian/Alaska Native groups were more likely to experience larger declines and slower or incomplete recovery.
- White and Black groups were more likely to experience stronger or more robust rebounds in some studies.
- Most studies did not provide detailed information on recovery patterns for all groups.