Key Insights on Current and Emerging Healthcare Issues

The Quest Diagnostics Health Trends® series of reports are drawn from our billions of data points to provide key insights into current healthcare issues. Health Trends reports in 2020 and 2021 have focused on important insights gained during the first years of the COVID-19 pandemic, including identifying significant declines in routine cancer screenings¹ as well as in recommended screenings for Americans at high risk for other serious medical conditions, including hepatitis C (HCV),² sexually transmitted infections (STIs),³ and diabetes management.⁴

Impact of pandemic-delayed testing and treatment

“We need to not only resume testing and treatment, but increase them above pre-pandemic levels to identify people who have delayed or skipped healthcare services. For serious and chronic conditions, a screening test is the first, and most critical, step.”
Harvey W. Kaufman, MD Senior Medical Director, Head of Health Trends Research

Particularly during the first months of the COVID-19 pandemic, nonemergent ambulatory and outpatient clinic services were limited to preserve healthcare resources for patients who were critically ill with COVID-19. Combined with other restrictions, generalized fear about the risk of contagion, and increased unemployment with loss of healthcare benefits, these limits had multiple unintended consequences, including decreases in screening that have already caused significant delays in diagnoses.

As a result, detection and diagnosis are happening at advanced stages rather than during early disease when treatment is most effective. Ultimately, this deferred care may lead to increases in late-stage disease, associated morbidity, and mortality.⁵

• ~60% of US adults delayed or skipped some in-person medical treatments or appointments during the pandemic, particularly Hispanic/Latinx adults (67%) as compared to White and Black adults (59% and 58%, respectively).⁶
• Concerns about exposure to the virus topped the list of reasons why US adults delayed or avoided in-person healthcare (53%), but many also recognize that this has now led to other health issues, including delayed diagnosis or treatment (18% and 23%, respectively) and worsening of symptoms (17%).⁶

Cancer diagnoses have increased

“In the past years, we’ve made so many therapeutic advances in cancer care, but if a cancer isn’t diagnosed, it can’t be treated.”
Kristie M. Dolan Vice President and General Manager, Oncology

On August 31, 2021, original research from Quest Diagnostics scientists was published in the Journal of the American Medical Association (JAMA) Network Open⁷ confirming one of the most dire unintended consequences of mitigation efforts to stop the COVID-19 pandemic: new diagnoses of the 8 most common cancer types in the US sharply declined during most of March 2020 to March 2021, the first year of the pandemic. This included cases of breast, prostate, colorectal, lung, pancreatic, esophageal, cervical, and gastric cancers.

After significant decreases in the rate of cancer death from 1991 to 2017,⁸ these crucial gains may be lost due to patients’ inability or reluctance to seek care, including regular cancer screenings, because of fear of the COVID-19 virus. In addition, the increased numbers of employees who lost their jobs due to business closures and COVID-19 mandates means a dramatic rise in numbers of Americans who were and may continue to be uninsured and thus even more reluctant to seek healthcare.

Without routine screenings, the ability to diagnose early-stage cancers when they are most treatable is greatly reduced. Accordingly, many healthcare providers predict an upcoming wave of patients who were living with undiagnosed cancers during the pandemic who are later diagnosed with advanced cancers, requiring more aggressive treatment and resulting in increased morbidity and mortality.⁹

Detectable lead levels in children’s blood

A study from Quest Diagnostics and Boston Children's Hospital found that 1 in 2 (50.5%) American children under 6 years of age tested have detectable levels of lead, a toxic metal, in their blood.⁴ It is the first study of its size and scale to examine blood lead levels (BLLs) as low as 1.0 μg/dL, which the researchers deemed “detectable” BLL. The researchers found that of the children tested¹⁰ :

• 50.5% had a detectable BLL of ≥1.0 μg/dL
• 1.9% had elevated BLL of ≥5.0 ug/dL

The research indicates that most American children have been exposed to lead, despite decades of public policy to reduce lead poisoning. A neurotoxin that causes irreversible health effects, including lower IQ, lead is found in many settings, including older homes, water pipes, areas with heavy industry, and some consumer products.

“Our Quest analysis finds that while exposure to the highest levels of lead has declined in recent years, most American children are exposed to lead, a substance that, according to the CDC, is not safe for children at any level. Moreover, our analysis finds that kids in areas with the highest rates of poverty are also the most at risk, highlighting the critical role of social disparities in health,” notes Senior Medical Director and Head of Health Trends Research Harvey W. Kaufman, MD.

Physicians worry about missing signs of drug misuse and fear fentanyl will be deadlier than opioids

“Clinical drug testing gives physicians the ability to uncover insights into problematic drug use before the worst outcomes can occur. [Although] our research shows that physicians overwhelmingly value clinical drug testing in patient management… there remains an unmet need for clear clinical guidelines regarding when and how to test, which tests to use, and the frequency of testing.”
Jeffrey Gudin, MD Senior Medical Advisor, Drug Monitoring and Toxicology

Based on a first-of-its-kind study conducted by Quest Diagnostics, the Health Trends report Drug Misuse in America 2021¹¹ examines the contributing factors to the significant increase in overdose deaths seen during the pandemic and provides insights on barriers health professionals face in their ability to monitor and intervene with their patients at risk for drug misuse.¹¹

Key findings from the report include¹¹:

• The pandemic worsened the drug crisis, and physicians anticipate a continuing rise in overdose deaths
• Physicians worry that they have missed signs of drug misuse during the pandemic and express concerns about recognizing signs of drug misuse during telehealth sessions
• Physicians fear that illicit fentanyl will claim more lives than prescribed opioids
• Despite physician confidence in counseling patients, nearly half of tested patients show drug misuse
• Clinical drug testing is deemed critical, but clearer guidelines would help optimize its use

Read more

_{1. Kaufman HW, Chen Z, Niles J, Radcliff J, Fesko YA. Changes in the number of US patients with newly identified cancer before and during the coronavirus disease 2019 (COVID-19) pandemic. JAMA Netw Open. 2020;3:e2017267. doi:10.1001/jamanetworkopen.2021.25681}

_{2. Kaufman HW, Bull-Otterson L, Meyer WA, et al. Decreases in hepatitis C testing and treatment during the COVID-19 pandemic. Am J Prev Med. 2021;61(3):369-376. doi:10.1016/j.amepre.2021.03.011}

_{3. Pinto CN, Niles JK, Kaufman HW, et al. Impact of the COVID-19 pandemic on chlamydia and gonorrhea screening in the U.S. Am J Prev Med. 2021;61(3):386-393. doi:10.1016/j.amepre.2021.03.009}

_{4. Fragala MS, Kaufman HW, Meigs JB, et al. Consequences of the COVID-19 pandemic: reduced hemoglobin A1c diabetes monitoring. Popul Health Manag. 2021;24(1):8-9. doi:10.1089/pop.2020.0134}

_{5. Cavallo J. How delays in screening and early cancer diagnosis amid the COVID-19 pandemic may result in increased cancer mortality: a conversation with NCI Director Norman E. ‘Ned’ Sharpless, MD. The ASCO Post. September 10, 2020. Accessed April 22, 2021. https://ascopost.com/issues/september-10-2020/how-delays-inscreening-and-early-cancer-diagnosis-amid-the-covid-19-pandemic-may-result-in-increased-cancer-mortality/}

_{6. Harris Poll of 2,050 US adults. November 10-12, 2020. Data on file. Quest Diagnostics, 2020.}

_{7. Kaufman HW, Chen Z, Niles JK, Fesko YA. Changes in newly identified cancer among US patients from before COVID-19 through the first full year of the pandemic. JAMA Netw Open. 2021;4(8):e2125681. doi:10.1001/jamanetworkopen.2021.25681}

_{8. Risk of dying from cancer continues to drop at an accelerated pace. American Cancer Society website. Published January 12, 2022. Accessed May 1, 2022. https://www.cancer.org/latest-news/facts-andfigures-2022.html}

_{9. Cavallo J. How delays in screening and early cancer diagnosis amid the COVID-19 pandemic may result in increased cancer mortality: a conversation with NCI Director Norman E. ‘Ned’ Sharpless, MD. The ASCO Post. September 10, 2020. Accessed April 22, 2021. https://ascopost.com/issues/september-10-2020/howdelays-in-screening-and-early-cancer-diagnosis-amid-the-covid-19-pandemic-may-result-in-increasedcancer-mortality/}

_{10. Hauptman M, Niles JK, Gudin J, Kaufman HW. Individual- and community-level factors associated with detectable and elevated blood lead levels in US children: results from a national clinical laboratory. JAMA Pediatr. 2021;175(12):1252-1260. doi:10.1001/jamapediatrics.2021.3518}

_{11. Harris Poll of 505 primary care physicians. August 12-19, 2021. Data on file. Quest Diagnostics, 2021.}

_{12. Kaufman HW, Gudin J, et al. Drug Misuse in America 2021: Physician Perspectives and Diagnostic Insights on the Drug Crisis and COVID-19. November 2021. Quest Diagnostics Health Trends® . Quest Diagnostics.}