Hyeda Adriano, da Costa Élide Sbardellotto Mariano, Kowalski Sérgio Cândido
Post-graduation Program in Internal Medicine from Federal University of Paraná (UFPR), Curitiba, Paraná, Brazil.
Public Health Department, Federal University of Paraná (UFPR), Curitiba, Brazil.
Ann Epidemiol. 2025 Jan;101:7-13. doi: 10.1016/j.annepidem.2024.12.001. Epub 2024 Dec 5.
There is a lack of research on whether COVID-19 disruptions in breast cancer screening, diagnosis, and treatment affected mortality rates over time.
This ecological time series study, covering the period between 2013 and 2023, utilizes the inflection point regression model and calculates the Annual Percentage Change (APC). The study used open-access data from the Brazilian Mortality Information System. The dependent variables measured were mortality rates due to breast cancer as an underlying cause and contributing cause in women aged 20 and over. The double exponential smoothing method was applied to predict mortality rates for 2020-2023.
During the study period, the mortality rate due to breast cancer as a contributing cause increased approximately tenfold compared to mortality as an underlying cause (APC 6.9 % vs. 0.7 %). On average, 12 % of breast cancer-related deaths were attributed to the disease as a contributing cause. Breast cancer deaths as an underlying cause declined in 2020 and 2021, remaining below the 95 % predicted interval (95 % PI), but showed recovery until 2023. Mortality due to breast cancer as a contributing cause increased early in the pandemic, with deaths related to COVID-19 as an underlying cause comprising 39.6 % of cases in 2021. Breast cancer-related deaths, both as an underlying and contributing cause, showed an upward trend until 2021 and remained within the 95 % PI until 2023.
During the pandemic, deaths due to breast cancer as an underlying cause decreased while contributing deaths increased, with total mortality remaining within the predicted range.
关于新冠疫情对乳腺癌筛查、诊断和治疗的干扰是否会随时间影响死亡率，目前缺乏相关研究。
这项生态时间序列研究涵盖2013年至2023年期间，采用拐点回归模型并计算年度百分比变化（APC）。该研究使用了巴西死亡率信息系统的开放获取数据。测量的因变量是20岁及以上女性中，乳腺癌作为根本死因和促成死因的死亡率。应用双指数平滑法预测2020 - 2023年的死亡率。
在研究期间，乳腺癌作为促成死因的死亡率相比作为根本死因的死亡率增加了约十倍（APC分别为6.9%和0.7%）。平均而言，12%的乳腺癌相关死亡归因于该疾病作为促成死因。乳腺癌作为根本死因的死亡人数在2020年和2021年下降，仍低于95%预测区间（95%PI），但到2023年有所恢复。乳腺癌作为促成死因的死亡率在疫情早期增加，2021年与新冠作为根本死因相关的死亡占病例的39.6%。乳腺癌相关死亡，无论是作为根本死因还是促成死因，在2021年前呈上升趋势，并在2023年前一直处于95%PI范围内。
在疫情期间，乳腺癌作为根本死因的死亡人数减少，而作为促成死因的死亡人数增加，总死亡率仍在预测范围内。
