Cancer epidemiology · 2026
Masked divergence in cancer mortality following COVID-19 disruption.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Soomro Mohammad Ahsen, Varghese Amy, Soomro Hala, Abdallah Al-Ola, Lutfi Forat G, Ahmed Nausheen
Аннотация
BACKGROUND: While overall cancer mortality in the United States has declined steadily for decades, systemic healthcare disruptions during the COVID-19 pandemic-including delays in screening, diagnosis, and treatment-may have created heterogeneous impacts across different malignancy types that are not visible in aggregate data.
OBJECTIVE: To determine whether site-specific cancer mortality during the COVID-19 pandemic (2020-2023) deviated from expected trajectories based on established pre-pandemic trends.
METHODS: This population-based analysis utilized U.S. National Vital Statistics System data from 2003 through 2023. Age-standardized mortality rates (AASRs) were calculated for specific cancer sites and modeled using log-linear regression over the baseline period (2003-2019). These models were used to project counterfactual expected mortality for the pandemic period (2020-2023). Excess mortality was defined as the percent difference between observed and projected AASRs, with significance determined via bootstrap simulation and false discovery rate correction.
RESULTS: Overall cancer mortality remained closely aligned with pre-pandemic declining projections. However, site-specific analysis revealed significant divergence. Positive excess mortality was observed for Hodgkin lymphoma (mean +9.5%; 95% CI, 2.7-17.2%) and prostate cancer (mean +7.9%; 95% CI, 2.8-13.2%). Additionally, mortality attributed to ill-defined malignant sites (+15.2%) and unspecified sites (+8.5%) increased significantly. Conversely, liver and intrahepatic bile duct cancers demonstrated mortality below expected levels (mean -15.5%; 95% CI, -19.5% to -11.3%). Most positive deviations peaked in 2022, suggesting a delayed effect of disrupted diagnostic and clinical pathways.
CONCLUSION: Aggregate cancer mortality trends during the pandemic masked significant, disease-specific divergences. The observed excess mortality in certain highly curable or screen-detected malignancies may reflect differential vulnerability to disruptions in screening, diagnosis, treatment access, or cause-of-death attribution. These findings highlight the need for site-specific surveillance to identify long-term consequences of systemic strain and to inform targeted recovery efforts in oncologic care.
OBJECTIVE: To determine whether site-specific cancer mortality during the COVID-19 pandemic (2020-2023) deviated from expected trajectories based on established pre-pandemic trends.
METHODS: This population-based analysis utilized U.S. National Vital Statistics System data from 2003 through 2023. Age-standardized mortality rates (AASRs) were calculated for specific cancer sites and modeled using log-linear regression over the baseline period (2003-2019). These models were used to project counterfactual expected mortality for the pandemic period (2020-2023). Excess mortality was defined as the percent difference between observed and projected AASRs, with significance determined via bootstrap simulation and false discovery rate correction.
RESULTS: Overall cancer mortality remained closely aligned with pre-pandemic declining projections. However, site-specific analysis revealed significant divergence. Positive excess mortality was observed for Hodgkin lymphoma (mean +9.5%; 95% CI, 2.7-17.2%) and prostate cancer (mean +7.9%; 95% CI, 2.8-13.2%). Additionally, mortality attributed to ill-defined malignant sites (+15.2%) and unspecified sites (+8.5%) increased significantly. Conversely, liver and intrahepatic bile duct cancers demonstrated mortality below expected levels (mean -15.5%; 95% CI, -19.5% to -11.3%). Most positive deviations peaked in 2022, suggesting a delayed effect of disrupted diagnostic and clinical pathways.
CONCLUSION: Aggregate cancer mortality trends during the pandemic masked significant, disease-specific divergences. The observed excess mortality in certain highly curable or screen-detected malignancies may reflect differential vulnerability to disruptions in screening, diagnosis, treatment access, or cause-of-death attribution. These findings highlight the need for site-specific surveillance to identify long-term consequences of systemic strain and to inform targeted recovery efforts in oncologic care.