Geographic inequalities in diagnostic testing delays in England before and after COVID

Diagnostic testing delays worsened during the COVID-19 pandemic, but it is unclear whether geographic inequalities have deepened. Using publicly-available data in England for nine tests, we compared waiting times across 106 local areas in 2019 and 2024–25. The national median proportion of patients waiting over six weeks increased from 2.2% to 18.8%, while geographic variation tripled. The greatest variation in 2024–25 occurred for flexible-sigmoidoscopy, colonoscopy, and echocardiography. These findings show that pandemic-related diagnostic delays persist and pre-existing geographic inequalities have deepened. Further research should examine how widening inequalities in waiting times influences downstream test demand and disease outcomes.