Wang Katarina, Canchola Alison J, McKinley Meg, Guan Alice, Vu Annie, Lin Katherine, Meltzer Dan, Dixit Niharika, Chu Janet N, Idossa Dame, Van Blarigan Erin L, Cheng Iona, Shariff-Marco Salma, Gomez Scarlett Lin
Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California.
School of Medicine and Dentistry, University of Rochester, Rochester, New York.
Cancer Epidemiol Biomarkers Prev. 2025 Jan 9;34(1):139-150. doi: 10.1158/1055-9965.EPI-24-0852.
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.
The study population included 349,458 adults in the California Cancer Registry diagnosed with cancer between January 2019 and 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.
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; prevalence ratio (PR), 1.41], low neighborhood socioeconomic status (nSES; vs. high; PR, 1.19), and racial and ethnic minoritized groups (vs. non-Hispanic White; PR, 1.04-1.19) had higher likelihood for late-stage cancer diagnosis.
The pandemic exacerbated late-stage cancer disparities for racial and ethnic minoritized groups, underinsured, and low nSES communities in California (2020-2021).
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.
新冠疫情及其相关封锁措施扰乱了医疗服务的可及性，导致癌症筛查减少。癌症诊断延迟对晚期癌症有令人担忧的下游影响，尤其是对边缘化人群。
研究人群包括加利福尼亚癌症登记处2019年1月至2021年12月期间诊断出患有癌症的349458名成年人，在此期间加利福尼亚实施了两次居家令。我们研究了五个时期晚期（III-IV期）癌症诊断的百分比：疫情前（2019年1月至2020年2月）、封锁1期（2020年3月至6月）、封锁1期后（2020年7月至11月）、封锁2期后（2020年12月至2021年3月）以及疫苗推出后（2021年4月至12月）。为了研究时期与晚期诊断之间的关联，我们进行了一个多变量对数二项回归模型，对社会人口学和邻里因素进行了调整。
封锁1期晚期癌症诊断的百分比增加（+5.2%），疫苗推出后恢复到基线水平。在封锁1期晚期癌症百分比增加明显高于总体人群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%）和未参保者（+7.4%）。未参保者[与私人保险相比；患病率比值（PR），1.41]、邻里社会经济地位低（nSES；与高相比；PR，1.19）以及少数族裔群体（与非西班牙裔白人相比；PR，1.04 - 1.19）晚期癌症诊断的可能性更高。
疫情加剧了加利福尼亚州（2020 - 2021年）少数族裔、保险不足以及邻里社会经济地位低的社区的晚期癌症差异。
改善癌症筛查的干预措施必须侧重于少数族裔、保险不足以及邻里社会经济地位低的社区，因为他们可能更容易受到疫情等医疗服务中断的影响。
