Have pulmonary function testing rates recovered post-COVID-19 pandemic? A population-based study

Pulmonary Function Tests are critical in diagnosing and managing respiratory conditions such as chronic obstructive pulmonary disease and asthma. However, because they generate aerosols, they were restricted in laboratories and offices during the COVID-19 pandemic to prevent virus spread.

To determine whether Pulmonary Function Test capacity had returned to pre-pandemic levels overall and across demographic groups in a large North American cohort.

We conducted a population cohort study in individuals aged 7 and older from 2015 to 2023 in Ontario, Canada, using provincial health administrative data. Incidence rate ratios (IRR) were used to compare observed rates to rates that would have been expected if the pandemic had never occurred and to assess whether test utilization returned to pre-pandemic levels. Subgroup analyses were conducted across various demographic characteristics.

There were 8,302,872 tests performed on 2,683,844 people during the study period. As of December 2023, testing rates were still 27% lower than they were prior to the pandemic (IRR 0.73, 95% CI 0.63 - 0.87). Recovery was lower in males (IRR 0.72, 95%CI 0.62-0.86), those aged 18-65 (IRR 0.68, 95%CI 0.59-0.82), urban residents (IRR 0.72, 95%CI 0.62-0.86), and individuals of lower socioeconomic status (IRR 0.68, 95%CI 0.59-0.81).

More than three years after the pandemic onset, pulmonary function test rates in Ontario still have not recovered to pre-pandemic levels, with certain groups more affected than others. These findings suggest persistent reductions in PFT utilization and disparities in care for people with respiratory conditions.