Cruz-Valdez Aurelio, Palacio-Mejía Lina Sofia, Quezada-Sánchez Amado D, Hernández-Ávila Juan Eugenio, Galicia-Carmona Tatiana, Cetina-Pérez Lucely Del Carmen, Arango-Bravo Eder A, Isla-Ortiz David, Aranda-Flores Carlos E, Uscanga-Sánchez Santos-Regino, Madrid-Marina Vicente, Torres-Poveda Kirvis
Center for Population Health Research, Instituto Nacional de Salud Pública (INSP), Cuernavaca, Mexico.
Consejo Nacional de Ciencia y Tecnología (CONACYT)-Instituto Nacional de Salud Pública (INSP), Cuernavaca, Mexico.
Front Oncol. 2023 Mar 9;13:1008560. doi: 10.3389/fonc.2023.1008560. eCollection 2023.
The COVID-19 pandemic disrupted the preventive services for cervical cancer (CC) control programs in Mexico, which will result in increased mortality. This study aims to assess the impact of the pandemic on the interruption of three preventive actions in the CC prevention program in Mexico.
This study is a retrospective time series analysis based on administrative records for the uninsured population served by the Mexican Ministry of Health. Patient data were retrieved from the outpatient service information system and the hospital discharge database for the period 2017-2021. Data were aggregated by month, distinguishing a pre-pandemic and a pandemic period, considering April 2020 as the start date of the pandemic. A Poisson time series analysis was used to model seasonal and secular trends. Five process indicators were selected to assess the disruption of the CC program, these were analyzed as monthly data (N=39 pre-pandemic, N=21 during the pandemic). HPV vaccination indicators (number of doses and coverage) and diagnostic characteristics of CC cases were analyzed descriptively. The time elapsed between diagnosis and treatment initiation in CC cases was modeled using restricted cubic splines from robust regression.
Annual HPV vaccination coverage declined dramatically after 2019 and was almost null in 2021. The number of positive Papanicolaou smears decreased by 67.8% (90%CI: -72.3, -61.7) in April-December 2020, compared to their expected values without the pandemic. The immediate pandemic shock (April 2020) in the number of first-time and recurrent colposcopies was -80.5% (95%CI:-83.5, -77.0) and -77.9% (95%CI: -81.0, -74.4), respectively. An increasing trend was observed in the proportion of advanced stage and metastatic CC cases. The fraction of CC cases that did not receive medical treatment or surgery increased, as well as CC cases that received late treatment after diagnosis.
Our analyses show significant impact of the COVID-19 pandemic with declines at all levels of CC prevention and increasing inequalities. The restarting of the preventive programs against CC in Mexico offers an opportunity to put in place actions to reduce the disparities in the burden of disease between socioeconomic levels.
新冠疫情扰乱了墨西哥宫颈癌（CC）防控项目的预防服务，这将导致死亡率上升。本研究旨在评估疫情对墨西哥CC预防项目中三项预防行动中断的影响。
本研究是一项基于墨西哥卫生部为未参保人群提供的行政记录的回顾性时间序列分析。患者数据从门诊服务信息系统和2017 - 2021年期间的医院出院数据库中获取。数据按月汇总，区分疫情前和疫情期间，将2020年4月视为疫情开始日期。采用泊松时间序列分析对季节性和长期趋势进行建模。选择了五个过程指标来评估CC项目的中断情况，这些指标作为月度数据进行分析（疫情前N = 39，疫情期间N = 21）。对HPV疫苗接种指标（接种剂量和覆盖率）以及CC病例的诊断特征进行了描述性分析。使用稳健回归中的受限立方样条对CC病例诊断与开始治疗之间的时间间隔进行建模。
2019年后年度HPV疫苗接种覆盖率大幅下降，2021年几乎为零。与无疫情时的预期值相比，2020年4月至12月巴氏涂片阳性数量减少了67.8%（90%置信区间：-72.3，-61.7）。首次和复发性阴道镜检查数量在疫情初期（2020年4月）的冲击分别为-80.5%（95%置信区间：-83.5，-77.0）和-77.9%（95%置信区间：-81.0，-74.4）。晚期和转移性CC病例的比例呈上升趋势。未接受治疗或手术的CC病例比例增加，以及诊断后接受延迟治疗的CC病例也增加。
我们的分析表明，新冠疫情产生了重大影响，CC预防的各个层面均出现下降，且不平等现象加剧。墨西哥重启CC预防项目为采取行动减少社会经济层面疾病负担差异提供了契机。
