Preventive Service Usage and New Chronic Disease Diagnoses: Using PCORnet Data to Identify Emerging Trends, United States, 2018-2022

Abstract

Background: Data modernization efforts to strengthen surveillance capacity could help assess trends in use of preventive services and diagnoses of new chronic disease during the COVID-19 pandemic, which broadly disrupted health care access.

Methods: This cross-sectional study examined electronic health record data from US adults aged 21 to 79 years in a large national research network (PCORnet), to describe use of 8 preventive health services (N = 30,783,825 patients) and new diagnoses of 9 chronic diseases (N = 31,588,222 patients) during 2018 through 2022. Joinpoint regression assessed significant trends, and health debt was calculated comparing 2020 through 2022 volume to prepandemic (2018 and 2019) levels.

Results: From 2018 to 2022, use of some preventive services increased (hemoglobin A_1c and lung computed tomography, both P < .05), others remained consistent (lipid testing, wellness visits, mammograms, Papanicolaou tests or human papillomavirus tests, stool-based screening), and colonoscopies or sigmoidoscopies declined (P < .01). Annual new chronic disease diagnoses were mostly stable (6% hypertension; 4% to 5% cholesterol; 4% diabetes; 1% colonic adenoma; 0.1% colorectal cancer; among women, 0.5% breast cancer), although some declined (lung cancer, cervical intraepithelial neoplasia or carcinoma in situ, cervical cancer, all P < .05). The pandemic resulted in health debt, because use of most preventive services and new diagnoses of chronic disease were less than expected during 2020; these partially rebounded in subsequent years. Colorectal screening and colonic adenoma detection by age group aligned with screening recommendation age changes during this period.

Conclusion: Among over 30 million patients receiving care during 2018 through 2022, use of preventive services and new diagnoses of chronic disease declined in 2020 and then rebounded, with some remaining health debt. These data highlight opportunities to augment traditional surveillance with EHR-based data.

Figure 1

Preventive service usage among unique patients, National Patient-Centered Clinical Research Network (PCORnet) sites, 2018–2022. Percentages of patients receiving mammograms and Papanicolaou (Pap) tests or human papillomavirus (HPV) tests are presented out of all women receiving care that year from participating PCORnet sites; percentages of all other preventive services are presented out of all patients (men and women) receiving care that year from participating PCORnet sites. Colonoscopy indicates colonoscopy or sigmoidoscopy. Stool-based test indicates stool-based colorectal test. Total unique patient counts by year: 2018: N = 12,236,819 overall, 7,247,376 women; 2019: N = 13,026,666 overall, 7,695,294 women; 2020: N = 13,353,937 overall, 7,820,064 women; 2021: N = 15,590,610 overall, 9,127,882 women; 2022: N = 13,826,891 overall, 8,146,879 women.

Figure 2

New chronic disease diagnoses among unique patients, National Patient-Centered Clinical Research Network (PCORnet) sites, 2018–2022. Percentages of patients newly diagnosed with breast cancer, cervical cancer, and cervical intraepithelial neoplasia or carcinoma in situ (CIN/CIS) are presented out of all women receiving care that year from participating PCORnet sites; percentages of patients diagnosed with all other conditions are presented out of all patients (men and women) receiving care that year from participating PCORnet sites. Cholesterol indicates initiation of a new cholesterol medication. Total unique patient counts by year: 2018: N = 12,262,754 overall, 7,264,953 women; 2019: N = 13,064,373 overall, 7,719,031 women; 2020: N = 13,402,584 overall, 7,849,336 women; 2021: N = 15,652,210 overall, 9,164,607 women; 2022: N = 15,506,288 overall, 9,128,281 women.