Abstract
Purpose :
The COVID-19 pandemic resulted in a decrease in Diabetic Retinopathy (DR) screenings during the lockdown period. We conducted a retrospective observational study of health claims data to investigate whether DR screening rates have returned to baseline in central Massachusetts during the years following the initial lockdown.
Methods :
Retrospective claims data from the UMass Memorial Managed Care Network, a system comprising over 1.7 million outpatient visits per year, were collected for the years of 2018-2022. Comprehensive and DR screening exams were identified using CPT codes for patients with Diabetes. The plans represented in the data include BCBS, HPHC, Tufts, and MSSP. Bivariate analysis was used to investigate the difference in weekly counts of DR screening exams before (03/05/2018 – 03/15/2020) and after (05/11/2020 – 05/22/2022) the lockdown through an independent sample t-test. Linear autoregressive models were used to estimate the effect of the COVID-19 pandemic on the weekly counts of DR screening exams and to identify whether patient status modifies this effect, adjusting for seasonal variation.
Results :
DR screening rates are significantly lower in the post-lockdown period compared to the pre-COVID-19 period (p-value < 0.0001). The mean DR screening weekly count was 6,773 for the pre-COVID-19 period and 5,695 for the post-lockdown period. Based on the results of the autoregressive model, the COVID-19 pandemic significantly affected DR screening rates adjusting for week-to-week and year-specific variation (p-value = 0.002). The association between the COVID-19 pandemic and DR screening rates is moderated by patient status, defined as whether the patient is new or established. Stratified analysis reveals that while the adjusted DR screening rate is not significantly different before and after the lockdown for new patients (p-value > 0.05), the adjusted rate is significantly lower after the lockdown for established patients (p-value = 0.0004).
Conclusions :
The impact of COVID-19 on DR screening and treatment rates has persisted even after the resumption of non-essential care services, with a discrepancy between new and established patients. Future research should work to identify the reasons why DR screening rates have not returned to their previous levels and ways to overcome this. Increased awareness of these continued screening deficits is essential to ensure the early detection of DR.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.