Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Catala De La Salut, Barcelona, Spain
Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Catala De La Salut, Barcelona, Spain.
BMJ Open. 2021 May 18;11(5):e047567. doi: 10.1136/bmjopen-2020-047567.
Cancer care has been disrupted by the response of health systems to the COVID-19 pandemic, especially during lockdowns. The objective of our study is to evaluate the impact of the pandemic on the incidence of cancer diagnoses in primary care.
Time-series study of malignant neoplasms and diagnostic procedures, using data from the primary care electronic health records from January 2014 to September 2020.
Primary care, Catalonia, Spain.
People older than 14 years and assigned in one of the primary care practices of the Catalan Institute of Health with a new diagnosis of malignant neoplasm.
We obtained the monthly expected incidence of malignant neoplasms using a temporary regression, where the response variable was the incidence of cancer from 2014 to 2018 and the adjustment variables were the trend and seasonality of the time series. Excess or lack of malignant neoplasms was defined as the number of observed minus expected cases, globally and stratified by sex, age, type of cancer and socioeconomic status.
Between March and September 2020 we observed 8766 (95% CI 4135 to 13 397) fewer malignant neoplasm diagnoses, representing a reduction of 34% (95% CI 19.5% to 44.1%) compared with the expected. This underdiagnosis was greater in individuals aged older than 64 years, men and in some types of cancers (skin, colorectal, prostate). Although the reduction was predominantly focused during the lockdown, expected figures have not yet been reached (40.5% reduction during the lockdown and 24.3% reduction after that).
Reduction in cancer incidence has been observed during and after the lockdown. Urgent policy interventions are necessary to mitigate the indirect effects of the COVID-19 pandemic and related control measures on other diseases and some strategies must be designed in order to reduce the underdiagnosis of cancer.
医疗系统对 COVID-19 大流行的应对措施严重扰乱了癌症治疗，尤其是在封锁期间。本研究旨在评估大流行对初级保健中癌症诊断发病率的影响。
使用 2014 年 1 月至 2020 年 9 月初级保健电子健康记录中的数据，对恶性肿瘤和诊断程序进行时间序列研究。
西班牙加泰罗尼亚的初级保健。
年龄大于 14 岁且被分配到加泰罗尼亚健康研究所的一个初级保健诊所的患者，这些患者有新诊断出的恶性肿瘤。
使用临时回归法获得恶性肿瘤的每月预期发病率，其中因变量为 2014 年至 2018 年的癌症发病率，调整变量为时间序列的趋势和季节性。整体以及按性别、年龄、癌症类型和社会经济地位分层，观察到的恶性肿瘤病例数减去预期病例数被定义为恶性肿瘤的过剩或缺乏。
2020 年 3 月至 9 月，我们观察到恶性肿瘤诊断减少了 8766 例（95%CI 4135 至 13397 例），与预期相比，减少了 34%（95%CI 19.5%至 44.1%）。这种漏诊在年龄大于 64 岁、男性和某些类型的癌症（皮肤、结直肠、前列腺）患者中更为严重。尽管减少主要集中在封锁期间，但尚未达到预期数字（封锁期间减少 40.5%，封锁后减少 24.3%）。
封锁期间和之后观察到癌症发病率下降。有必要采取紧急政策干预措施来减轻 COVID-19 大流行及其相关控制措施对其他疾病的间接影响，并且必须设计一些策略以减少癌症的漏诊。
