Disparities in cancer stage shifts associated with the COVID-19 pandemic in California, 2020-2021.

IF 3.7 3区医学 Q2 ONCOLOGY Cancer Epidemiology Biomarkers & Prevention Pub Date : 2024-10-31 DOI:10.1158/1055-9965.EPI-24-0852

Katarina Wang, Alison J Canchola, Meg McKinley, Alice Guan, Annie Vu, Katherine Lin, Dan Meltzer, Niharika Dixit, Janet N Chu, Dame Idossa, Erin L Van Blarigan, Iona Cheng, Salma Shariff-Marco, Scarlett Lin Gomez

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Abstract

Background: The COVID-19 pandemic and associated shutdowns disrupted healthcare access and resulted in decreased cancer screenings. Cancer diagnosis delays have concerning downstream effects on late-stage cancer, especially for marginalized populations.

Methods: The study population included 349,458 adults in the California Cancer Registry diagnosed with cancer between January 2019-December 2021, during which California experienced two stay-at-home orders. We examined the percentage of late-stage (III-IV) cancer diagnoses across five periods: Pre-Pandemic (January 2019-February 2020), Shutdown #1 (March-June 2020), Post-Shutdown #1 (July-November 2020), Post-Shutdown #2 (December 2020-March 2021), and Post-Vaccine Rollout (April-December 2021). To examine the association between time-period and late-stage diagnoses, we conducted a multivariable log binomial regression model adjusted for sociodemographic and neighborhood factors.

Results: The percentage of late-stage cancer diagnoses increased during Shutdown #1 (+5.2%) and returned to baseline Post-Vaccine Rollout. Groups with notably higher increases in the percentage of late-stage cancer (vs. overall population) during Shutdown #1 include: Pacific Islander (+13.7%), Thai (+11.2%), Chinese (+8.1%), Native Hawaiian (+7.4%), Filipino (+6.6%), and uninsured (+7.4%). Uninsured (vs. private insurance) (PR: 1.41), low neighborhood SES (nSES) (vs. high) (PR: 1.19), and racial and ethnic minoritized groups (vs. NH White) (PR's: 1.04-1.19) had higher likelihood for late-stage cancer diagnosis.

Conclusions: The pandemic exacerbated late-stage cancer disparities for racial and ethnic minoritized groups, underinsured, and low nSES communities in California (2020-2021).

Impact: Interventions to improve cancer screening must be focused on racial and ethnic minoritized, underinsured, and low nSES communities, as they are likely to be more vulnerable to healthcare disruptions like the pandemic.

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2020-2021 年加利福尼亚州与 COVID-19 大流行相关的癌症分期转移差异。

背景：COVID-19 大流行和相关的停工扰乱了医疗保健服务，导致癌症筛查减少。癌症诊断延误会对晚期癌症产生令人担忧的下游影响，尤其是对边缘化人群：研究对象包括加利福尼亚癌症登记处在 2019 年 1 月至 2021 年 12 月期间确诊患有癌症的 349,458 名成年人，在此期间，加利福尼亚经历了两次停摆。我们研究了五个时期的晚期（III-IV 期）癌症诊断比例：大流行前（2019 年 1 月至 2020 年 2 月）、1 号停工令（2020 年 3 月至 6 月）、1 号停工令后（2020 年 7 月至 11 月）、2 号停工令后（2020 年 12 月至 2021 年 3 月）和疫苗推广后（2021 年 4 月至 12 月）。为了研究时间段与晚期诊断之间的关系，我们建立了一个多变量对数二项式回归模型，并对社会人口和邻里因素进行了调整：结果：晚期癌症诊断比例在 1 号停产期间有所上升（+5.2%），在疫苗推广后恢复到基线水平。在 1 号关机期间，晚期癌症比例（与总人口相比）明显增加的群体包括太平洋岛民（+13.7%）、泰国人（+11.2%）、中国人（+8.1%）、夏威夷原住民（+7.4%）、菲律宾人（+6.6%）和无保险者（+7.4%）。无保险（与私人保险相比）（PR：1.41）、低社区社会经济地位（nSES）（与高社区社会经济地位相比）（PR：1.19）以及少数种族和族裔群体（与新罕布什尔州白人相比）（PR：1.04-1.19）被诊断为癌症晚期的可能性更高：结论：大流行加剧了加利福尼亚州（2020-2021 年）少数种族和族裔群体、保险不足以及社会经济地位低的社区的晚期癌症差异：影响：改善癌症筛查的干预措施必须重点关注少数种族和族裔、保险不足以及社会经济地位低下的群体，因为他们可能更容易受到大流行病等医疗保健干扰的影响。

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来源期刊

Cancer Epidemiology Biomarkers & Prevention 医学-公共卫生、环境卫生与职业卫生

CiteScore

6.50

自引率

2.60%

发文量

538

审稿时长

1.6 months

期刊介绍： Cancer Epidemiology, Biomarkers & Prevention publishes original peer-reviewed, population-based research on cancer etiology, prevention, surveillance, and survivorship. The following topics are of special interest: descriptive, analytical, and molecular epidemiology; biomarkers including assay development, validation, and application; chemoprevention and other types of prevention research in the context of descriptive and observational studies; the role of behavioral factors in cancer etiology and prevention; survivorship studies; risk factors; implementation science and cancer care delivery; and the science of cancer health disparities. Besides welcoming manuscripts that address individual subjects in any of the relevant disciplines, CEBP editors encourage the submission of manuscripts with a transdisciplinary approach.