Association of Cancer Screening Deficit in the United States With the COVID-19 Pandemic
Association of Cancer Screening Deficit in the United States With the COVID-19 Pandemic
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DOI：
10.1001/jamaoncol.2021.0884
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发表时间：
2021-04-29
期刊：
影响因子：
28.4
通讯作者：
Katz, Aaron J.
中科院分区：
文献类型：
--
作者：
Chen, Ronald C.;Haynes, Kevin;Katz, Aaron J.
新冠肺炎疫情的重要性导致癌症筛查大幅下降。然而，与新冠肺炎大流行相关的美国筛查总缺陷以及对不同地理区域和社会经济状况(SES)指数的个人的不同影响尚未完全表征。目的量化不同地理区域和不同SES指数四分位数的乳腺癌、结直肠癌和前列腺癌的筛查率，并估计2020年美国人口中总体癌症筛查缺陷。设计、设置和参与者这项回溯性队列研究使用HealthCore综合研究数据库，它包括单一付款人管理索赔数据和登记信息，涵盖美国不同地理区域的约6000万人参加Medicare Advantage和商业健康计划。参与者是数据库中2018年1月至7月、2019年和2020年7月的个人，在分析指数月之前没有被诊断出感兴趣的癌症。EXPOSURES分析指数月和年。主要结果和衡量乳腺癌、结直肠癌或前列腺癌筛查的接收情况。结果与2019年相比，2020年3月至5月对所有三种癌症的筛查都大幅下降，其中4月份的降幅最大(乳腺癌，-90.8%；结直肠癌，-79.3%；前列腺癌，-63.4%)，到7月，乳腺癌和前列腺癌的月筛查率几乎完全恢复。全美人群在新冠肺炎大流行相关筛查方面的绝对缺口估计为390万(乳房)、380万(结直肠)和160万(前列腺癌)。观察到了地理上的差异：东北部地区的筛查下降幅度最大，而西部地区的复苏速度慢于中西部和南部地区。例如，4月份乳腺癌筛查率(2020年与2019年)的百分比变化从西部的-87.3%(95%CI，-87.9%至-86.7%)到东北部的-94.5%(95%CI，-94.9%至-94.1%)(下降)。7月份，从中西部的-0.3%(95%CI，-2.1%至1.5%)到西部(复苏)的-10.6%(-12.6%至-8.4%)。根据SES，在SES指数最高的四分位数的个人中观察到的筛查降幅最大，导致SES在2020年癌症筛查中的差距缩小。例如，与2020年4月的1535(95%CI，1480至1589)和1338(95%CI，1306至1370)相比，2019年4月，SES指数四分位数最低和最高的个人每10万登记人的前列腺癌筛查率分别为3525(95%CI，3444至3607)和4329(95%CI，4271至4386)。多变量分析表明，远程医疗的使用与更高的癌症筛查有关。结论需要公共卫生努力来解决与新冠肺炎大流行相关的巨大癌症筛查缺陷，包括增加使用不需要程序的筛查方式。问题：新冠肺炎大流行与全美癌症筛查率有什么关联？研究结果发现，随着2020年乳腺癌、结直肠癌和前列腺癌每月筛查率的急剧下降和随后的恢复，美国人口中与新冠肺炎大流行相关的筛查缺陷估计仍为940万。筛查下降因地理区域和社会经济状况指数而异，远程医疗的使用与较高的筛查率相关。这意味着需要公共卫生努力来弥补与新冠肺炎大流行相关的巨大癌症筛查缺口。
IMPORTANCE The COVID-19 pandemic led to sharp declines in cancer screening. However, the total deficit in screening in the US associated with the pandemic and the differential impact on individuals in different geographic regions and by socioeconomic status (SES) index have yet to be fully characterized.OBJECTIVES To quantify the screening rates for breast, colorectal, and prostate cancers associated with the COVID-19 pandemic in different geographic regions and for individuals in different SES index quartiles and estimate the overall cancer screening deficit in 2020 across the US population.DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study uses the HealthCore Integrated Research Database, which comprises single-payer administrative claims data and enrollment information covering approximately 60 million people in Medicare Advantage and commercial health plans from across geographically diverse regions of the US. Participants were individuals in the database in January through July of 2018, 2019, and 2020 without diagnosis of the cancer of interest prior to the analytic index month.EXPOSURES Analytic index month and year.MAIN OUTCOMES AND MEASURES Receipt of breast, colorectal, or prostate cancer screening.RESULTS Screening for all 3 cancers declined sharply in March through May of 2020 compared with 2019, with the sharpest decline in April (breast, -90.8%; colorectal, -79.3%; prostate, -63.4%) and near complete recovery of monthly screening rates by July for breast and prostate cancers. The absolute deficit across the US population in screening associated with the COVID-19 pandemic was estimated to be 3.9 million (breast), 3.8 million (colorectal), and 1.6 million (prostate). Geographic differences were observed: the Northeast experienced the sharpest declines in screening, while the West had a slower recovery compared with the Midwest and South. For example, percentage change in breast cancer screening rate (2020 vs 2019) for the month of April ranged from -87.3% (95% CI, -87.9% to -86.7%) in the West to -94.5% (95% CI, -94.9% to -94.1%) in the Northeast (decline). For the month of July, it ranged from -0.3% (95% CI, -2.1% to 1.5%) in the Midwest to -10.6% (-12.6% to -8.4%) in the West (recovery). By SES, the largest screening decline was observed in individuals in the highest SES index quartile, leading to a narrowing in the disparity in cancer screening by SES in 2020. For example, prostate cancer screening rates per 100 000 enrollees for individuals in the lowest and highest SES index quartiles, respectively, were 3525 (95% CI, 3444 to 3607) and 4329 (95% CI, 4271 to 4386) in April 2019 compared with 1535 (95% CI, 1480 to 1589) and 1338 (95% CI, 1306 to 1370) in April 2020. Multivariable analysis showed that telehealth use was associated with higher cancer screening.CONCLUSIONS AND RELEVANCE Public health efforts are needed to address the large cancer screening deficit associated with the COVID-19 pandemic, including increased use of screening modalities that do not require a procedure.Question What was the association of the COVID-19 pandemic with cancer screening rates across the US?Findings This cohort study found that with sharp declines and subsequent recoveries of breast, colorectal, and prostate cancer monthly screening rates in 2020, there remained an estimated screening deficit of 9.4 million associated with the COVID-19 pandemic for the US population. Screening declines differed by geographic region and socioeconomic status index, and use of telehealth was associated with higher screening rates.Meaning Public health efforts are needed to make up the large cancer screening deficit associated with the COVID-19 pandemic.