Racial Disparities in Newly Diagnosed Hematological Malignancies in the United States during the COVID-19 Pandemic, January 2020 to March 2021

Background:

Recent evidence in solid cancers indicates a significant decline in newly diagnosed cancer patients during the COVID-19 pandemic. However, there is little research on such trends in hematological cancers. Additionally, segmentation of such trends by race has been largely unexplored. Our research deals with these gaps in the literature.

Methods:

We used ConcertAI's oncology EMR database of clinical data from CancerLinQ Discovery^TM. We chose a subset of patients who were newly assigned International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis codes associated with the 21 most prevalent hematological malignancies between January 2019 to March 2021. These malignancies were rolled up into three major blood disorders: leukemia, lymphoma, and myeloma.

Monthly diagnosis averages and total counts were evaluated for four periods: pre-pandemic (January 2019 to February 2020), pandemic period 1 (March to May 2020), pandemic period 2 (June to October 2020), and pandemic period 3 (November 2020 to March 2022). We chose these periods based on the published literature.

We conducted two sets of chi-squared statistical tests. First, we compared the trends across pandemic periods for each hematological cancer group. Second, we compared Black versus White cancer diagnosis counts between pre-pandemic and pandemic period 3. Results were considered statistically significant at P < 0.05. Analyses were performed using Python 3.9.

Results:

The table below is the result of our first analysis. It shows the mean as well as the total number of newly diagnosed patients, segmented by race and time period. Compared to the pre-pandemic period, mean monthly patient numbers dropped during the pandemic for all cancer types. The pre-pandemic period saw a mean monthly diagnosis of 3645 patients, pandemic period 1 had 2295 patients, pandemic period 2 had 2523 patients, and pandemic period 3 had 2410 patients.

The figure below represents our second analysis, where we found that racial disparities in hematologic cancer diagnosis among White and Black patients improved during the COVID-19 pandemic. Compared to Whites, the percentage of Black patients diagnosed increased from 21.0% pre-pandemic to 23.8% (P=0.01) in pandemic period 3 in myeloma, from 13.6% to 14.7% (P=0.02) in leukemia, and from 11.0% to 12.3% (P=0.01) for lymphoma.

Conclusion:

Our results showed an overall decline in the diagnosis of hematological malignancies during the COVID-19 pandemic. However, we also found a statistically significant increase in the cancer diagnosis among Black populations. We know from the literature that Blacks were disproportionately affected by COVID-19, resulting in higher rates of hospitalization. We hypothesize that such increased hospitalization led to increased access to cancer diagnosis resources and as a result, higher rates of incidental findings of cancer among Blacks. This suggests the importance of increasing access to improve racial disparities in cancer diagnosis.

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