Changes in Youth Cholesterol Screening Rates in an Academic Center During the COVID-19 Pandemic.

Screening youth for hypercholesterolemia allows for detection of familial hypercholesterolemia that can predispose to premature heart disease, however guidelines provide conflicting recommendations regarding universal cholesterol screening. The COVID-19 pandemic and the perception of conflicting guideline recommendations (2011 National Heart, Lung, and Blood Institute guidelines and United States Preventive Services Task Force recommendations in 2016 and 2023) may have adversely affected youth cholesterol screening rates. This study examines screening rates during and after the COVID-19 pandemic and the most recent guideline update. Electronic health record data from a single academic institution was used to calculate Order Placement Rates (OPRs) for subjects aged 8 years 9 months-21 years from 3/18/2019 to 12/31/2023. Demographic data included subject sex, age, zip code, and primary provider's specialty. Zip codes were categorized as rural/urban and underserved/middle/advantaged. The study period was divided into five stages (pre-pandemic, mid-pandemic, late-pandemic, post-pandemic, and post-guideline). Relative to baseline OPR prior to 3/18/2019, study period OPRs decreased slightly in pre-pandemic (73.3%), mid-pandemic (70.9%), and late-pandemic (65.4%) stages, with sharper declines during post-pandemic (47.6%) and post-guideline stages (35.2%). OPR decreased more significantly for youth 9-11 years than 17-21 years (post-guideline OPR: 35.1% versus 46.9%). Urban underserved and urban advantaged had higher OPRs. OPRs for family medicine and pediatrics declined (p < 0.01), more significantly in pediatrics (post-guideline versus pre-pandemic OPR adjusted odds ratio [95% CI] = 0.03 [0.02-0.04] for pediatrics, 0.35 [0.30-0.40] for family medicine). Our institution showed decreases in cholesterol screening OPRs after both the COVID-19 pandemic and guideline update. OPRs dropped most significantly among youth aged 9-11 years and among pediatric providers. Urban youth were more likely to be screened than rural youth. Discrepancies persist among access to youth cholesterol screening.