1. Epidemiology and Global Health

The impact of COVID-19 on cancer screening and treatment in older adults: The Multiethnic Cohort Study

  1. Victoria P Mak  Is a corresponding author
  2. Kami White
  3. Lynne R Wilkens
  4. Iona Cheng
  5. Christopher A Haiman
  6. Loic Le Marchand
  1. Population Sciences in the Pacific Program (Cancer Epidemiology), University of Hawaii Cancer Center, University of Hawaii at Manoa, United States
  2. Department of Epidemiology and Biostatistics, University of California, San Francisco, United States
  3. Center for Genetic Epidemiology, University of Southern California, United States
https://doi.org/10.7554/eLife.86562
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  1. Victoria P Mak
  2. Kami White
  3. Lynne R Wilkens
  4. Iona Cheng
  5. Christopher A Haiman
  6. Loic Le Marchand
(2023)
The impact of COVID-19 on cancer screening and treatment in older adults: The Multiethnic Cohort Study
eLife 12:e86562.
https://doi.org/10.7554/eLife.86562
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1 figure, 6 tables and 4 additional files

Figures

Figure 1
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Timeline of the MEC COVID-19 Study.

Tables

Table 1
Demographics of baseline COVID survey participants from Hawai‘i and Los Angeles (May-September 2020, N=6974).
MaleN (%) or Mean ±SDFemaleN (%) or Mean ±SD
3034 (43.5)3940 (56.5)
Race/EthnicityWhite1371 (45.2)1683 (42.7)
Japanese American1059 (34.9)1195 (30.3)
Latino241 (7.9)291 (7.4)
Native Hawaiian194 (6.4)320 (8.1)
African American107 (3.5)257 (6.5)
Other*62 (2.0)194 (4.9)
Age (years)66–72.8715 (23.57)946 (24.01)
72.8–74.6787 (25.94)1008 (25.58)
74.6–77.9796 (26.24)979 (24.85)
77.9–102736 (24.26)1007 (25.56)
Age (years)76±4.976±5.3
Years of Education †,‡15.86±2.115.48±2.2
Pack Years†,‡ (MEC baseline 1993–1996)8.57±12.45.16±9.9
Alcohol Intake†,‡ (g/day) (MEC baseline 1993–1996)12.65±20.75.15±11.8
Number of Days an Alcoholic Beverage was Consumed in the Past 2 Weeks†,‡4.61±5.62.83±4.7
Number of Days with 5 or More Drinks Consumed on the Same Occasion in the Past 2 Weeks†,‡0.37±1.80.07±0.8
Dietary Patterns Healthy Eating Index-2010 score†,‡
(MEC Baseline 1993–1996)		64.95±10.868.66±10.5
Made Lifestyle and Healthcare Changes Due to COVID-19 Since March 2020‡2361 (78.8)3272 (84.4)
Drinking Behavior Change Due to COVID-19‡Do Not Drink1185 (39.6)2051 (53.5)
Drink More125 (4.2)163 (4.3)
Drink Less189 (6.3)199 (5.2)
Same1492 (49.9)1421 (37.1)
BMI (kg/m2)†,‡26.8±4.625.9±5.8
Smoking Status‡Never1320 (44.0)2275 (58.7)
Not currently, but in the past1568 (52.3)1505 (38.8)
Yes110 (3.7)99 (2.6)
Have Healthcare Coverage‡Yes2,972 (99.2)3,837 (99.2)
I don’t know / not sure3 (0.1)2 (0.1)
No21 (0.7)28 (0.7)
Has Primary Care Provider/Physician ‡2908 (97.0)3767 (97.4)
  1. *

    Comprised of a majority of Chinese Americans (38.1%) and Filipino (36.6%).

  2. †

    Mean ± SD; other numbers are counts (and percentages).

  3. ‡

    For education attained, there are missing responses from 16 men and 27 women. For the other questions asked in the MEC baseline and COVID survey, the missing responses range from 35-51 for men and 57–106 for women.

Table 2
Distribution for postponing regular health care visits due to COVID-19 pandemic by sex (N=6974).
MaleN (%)FemaleN (%)
Postponed regular health care visits1625 (54.2)2369 (61.3)
 Missing3872
 Primary care physician8581188
 Oncologist54105
 Cardiologist207147
 Endocrinologist4474
 Dentist9541453
 Other7681416
Table 3
Distribution for postponing cancer screening test/procedure/treatment due to COVID-19 pandemic by sex (N=6974).
MaleN (%)FemaleN (%)
Postponed any cancer screening test/procedure169 (5.7)422 (11.0)
 Missing4887
 Breast cancer screening (e.g. mammography, breast MRI)-264
 Colorectal cancer screening (e.g. FOBT test, FIT test, colonoscopy, sigmoidoscopy)4272
 Skin cancer screening (e.g. skin exam)83124
 Prostate cancer screening (digital rectal examination, PSA)25-
 Cervical cancer screening (e.g. PAP smear, pelvic exam)*-18
 Imaging (e.g. CAT scan, DEXA, MRI)*1224
 Other2429
Currently on chemotherapy, immunotherapy, or radiation therapy for cancer103 (3.4)135 (3.4)
 Chemotherapy3130
 Immunotherapy2219
 Radiation Therapy168
Postponed any cancer therapy session(s)7 (11.5)4 (6.9)
 Missing29733882
  1. *

    Categories created by sorting text responses in the ‘Other Specify’ answer choice.

Table 4
Odds Ratio* for change in lifestyle or daily activities since onset of COVID-19 pandemic by demographics and comorbidities.
Male (N=3000)Female (N=3890)
Yes (n)Odds Ratio(95% CI)p-ValueYes (n)Odds Ratio(95% CI)p-Value
Ethnicity
 White (N=3,031)10831.00 (Ref)1,4481.00 (Ref)
 Japanese American (N=2,228)8331.02 (0.83,1.26)0.839940.86 (0.69,1.07)0.17
 Latino (N=520)1770.99 (0.70,1.40)0.962330.94 (0.65,1.35)0.73
 Native Hawaiian (N=509)1350.59 (0.42,0.84)0.0032350.44 (0.33,0.60)<.0001
 African American (N=354)962.54 (1.30,4.99)0.012110.96 (0.64,1.43)0.82
 Other (N=248)370.44 (0.25,0.78)0.011510.62 (0.41,0.92)0.02
Age (Years) (N=6,890)23610.98 (0.96,1.00)0.0232720.97 (0.96,0.99)0.001
Maximum Education Obtained (Years) (N=6,847)23471.12 (1.07,1.17)<0.000132481.10 (1.06,1.15)<0.0001
Comorbidities
 None (N=2,307)†6941.00 (Ref)11401.00 (Ref)
 Heart Disease (N=1,035)5191.41 (1.11,1.80)0.013561.19 (0.86,1.63)0.29
 Hypertension (N=3,271)11691.34 (1.11,1.62)0.00215451.21 (1.00,1.47)0.05
 Diabetes (N=1,106)4240.87 (0.68,1.10)0.254620.90 (0.69,1.16)0.40
 Lung Disease, COPD, or Asthma (N=819)2491.41 (1.01,1.96)0.044661.65 (1.22,2.23)0.001
 Kidney Disease (N=340)1381.37 (0.87,2.13)0.171501.11 (0.70,1.76)0.65
 Diagnosed w/ Cancer in past 5 yrs. (N=921)3831.09 (0.84,1.40)0.513831.21 (0.89,1.64)0.22
  1. *

    Adjusted for the other variables in the table. Male (Reference) vs. Female: OR = 1.62 (95% CI: 1.42,1.84; p<0.0001).

  2. †

    Number of respondents who did not answer affirmatively for any listed co-morbidities.

Table 5
Odds ratio* for postponing regular health care visits due to COVID-19 pandemic by demographics and comorbidities.
Male (N=2998)Female (N=3881)
Yes (n)Odds Ratio(95% CI)p-ValueYes (n)Odds Ratio(95% CI)p-Value
Ethnicity
 White (N=3,026)7701.00 (Ref)1,0421.00 (Ref)
 Japanese American (N=2,224)5600.88 (0.74,1.04)0.137150.93 (0.80,1.09)0.38
 Latino (N=519)1140.74 (0.55,0.99)0.041871.32 (0.99,1.76)0.06
 Native Hawaiian (N=508)880.64 (0.47,0.88)0.0051630.60 (0.47,0.78)0.0001
 African American (N=354)611.01 (0.67,1.52)0.981551.01 (0.75,1.34)0.97
 Other (N=248)320.87 (0.51,1.49)0.621070.77 (0.56,1.05)0.10
Age (Years) (N=6,879)1,6251.00 (0.99,1.02)0.852,3690.98 (0.97,0.99)0.001
Maximum Education Obtained (Years) (N=6,836)1,6171.04 (1.00,1.08)0.042,3541.03 (1.00,1.06)0.10
Comorbidities
 None (N=2,301)†4451.00 (Ref)8001.00 (Ref)
 Heart Disease (N=1,032)3821.37 (1.13,1.65)0.0012661.18 (0.94,1.49)0.16
 Hypertension (N=3,266)8191.16 (1.00,1.35)0.061,1411.16 (1.00,1.33)0.04
 Diabetes (N=1,106)3141.15 (0.94,1.40)0.183461.00 (0.82,1.22)1.00
 Lung Disease, COPD, or Asthma (N=821)1791.25 (0.98,1.61)0.083351.12 (0.92,1.36)0.26
 Kidney Disease (N=339)1001.16 (0.83,1.62)0.401231.49 (1.05,2.11)0.03
 Diagnosed w/ Cancer in past 5 yrs. (N=920)2681.04 (0.85,1.27)0.733051.51 (1.21,1.88)0.0003
  1. *

    Adjusted for the other variables in the table. Male (Reference) vs. Female: OR = 1.43 (95% CI: 1.29,1.58; p<0.0001).

  2. †

    Number of respondents who did not answer affirmatively for any listed co-morbidities.

Table 6
Odds ratio* for postponing cancer screening test/procedure due to COVID-19 pandemic by demographics and comorbidities.
Male (N=2988)Female (N=3866)
Yes (n)Odds Ratio(95% CI)p-ValueYes (n)Odds Ratio(95% CI)p-Value
Ethnicity
 White (N=3,018)1231.00 (Ref)2271.00 (Ref)
 Japanese American (N=2220)230.28 (0.18,0.45)<0.0001900.60 (0.46,0.78)0.0002
 Native Hawaiian (N=508)70.48 (0.21,1.05)0.07320.73 (0.48,1.11)0.14
 African American (N=353)70.90 (0.40,2.03)0.81271.01 (0.65,1.57)0.96
 Latino (N=509)80.48 (0.23,1.03)0.06250.90 (0.57,1.44)0.66
 Other10.24 (0.03,1.80)0.17210.86 (0.53,1.41)0.55
Age (Years) (N=6854)1690.96 (0.93,1.00)0.064220.96 (0.94,0.98)0.001
Maximum Education Obtained (Years) (N=6,811)1661.03 (0.95,1.12)0.504211.10 (1.05,1.16)0.0004
Comorbidities
 None (N=2295)†471.00 (Ref)1211.00 (Ref)
 Heart Disease (N=1028)290.82 (0.53,1.27)0.37521.21 (0.87,1.69)0.27
 Hypertension (N=3255)751.07 (0.76,1.50)0.701951.07 (0.86,1.34)0.56
 Diabetes (N=1099)220.88 (0.54,1.44)0.61530.83 (0.59,1.16)0.27
 Lung Disease, COPD, or Asthma (N=815)170.84 (0.48,1.47)0.54791.50 (1.14,1.98)0.004
 Kidney Disease (N=337)70.89 (0.40,2.00)0.78180.94 (0.55,1.58)0.80
 Diagnosed w/ Cancer in past 5 yrs. (N=918)713.54 (2.52,4.95)<0.00011123.22 (2.50,4.14)<0.0001
  1. *

    Adjusted for the other variables in the table. Male (Reference) vs. Female: OR = 2.37 (95% CI: 1.95,2.88; p<0.0001).

  2. †

    Number of respondents who did not answer affirmatively for any listed co-morbidities.

Additional files

Supplementary file 1

Comparison of Ethnicity and Educational Level between 2019 MEC Cohort Survivors and 2020 COVID Survey Participants.

https://cdn.elifesciences.org/articles/86562/elife-86562-supp1-v2.docx
Supplementary file 2

Distribution of Baseline COVID Survey Participants by Health Status, Comorbidities, and Medication Use, Hawai‘i and Los Angeles (N=6,974).

https://cdn.elifesciences.org/articles/86562/elife-86562-supp2-v2.docx
Supplementary file 3

Distribution for Postponing Regular Health Care Visits Due to COVID-19 Pandemic by Sex (N=6,974).

https://cdn.elifesciences.org/articles/86562/elife-86562-supp3-v2.docx
MDAR checklist
https://cdn.elifesciences.org/articles/86562/elife-86562-mdarchecklist1-v2.pdf

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  1. Victoria P Mak
  2. Kami White
  3. Lynne R Wilkens
  4. Iona Cheng
  5. Christopher A Haiman
  6. Loic Le Marchand
(2023)
The impact of COVID-19 on cancer screening and treatment in older adults: The Multiethnic Cohort Study
eLife 12:e86562.
https://doi.org/10.7554/eLife.86562