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da Cunha AR, Antunes JLF. Impact of the COVID-19 pandemic on cancer mortality in Brazil. BMC Cancer 2024; 24:1125. [PMID: 39256699 PMCID: PMC11384704 DOI: 10.1186/s12885-024-12761-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 08/05/2024] [Indexed: 09/12/2024] Open
Abstract
BACKGROUND In the first year of the COVID-19 pandemic, data projections indicated an increase in cancer mortality for the following years due to the overload of health services and the replacement of health priorities. The first studies published with data from mortality records have not confirmed these projections. However, cancer mortality is not an outcome that occurs immediately, and analyses with more extended follow-up periods are necessary. This study aims to analyze the impact of the COVID-19 pandemic on the mortality from all types and the five most common types of cancer in Brazil and investigate the relationship between the density of hospital beds and mortality from COVID-19 in cancer patients in Brazil's Intermediate Geographic Regions (RGIs). METHODS The Brazilian Mortality Information System provided data on the deaths from trachea, bronchus, and lung, colorectal, stomach, female breast, and prostate cancer and all types of cancer, and from COVID-19 in individuals who had cancer as a contributing cause of death. Predicted rates for 2020-2022 were compared with the observed ones, through a rate ratio (RR). An association analysis, through multivariate linear regression, was carried out between mortality from COVID-19 in cancer patients, the rate of hospital beds per 100,000 inhabitants, and the Human Development Index of the 133 RGIs of Brazil. RESULTS In 2020, 2021, and 2022, mortality from all cancers in Brazil was lower than expected, with an RR of 0.95, 0.94, and 0.95, respectively, between the observed and predicted rates. Stomach cancer showed the largest difference between observed and expected rates: RR = 0.89 in 2020 and 2021; RR = 0.88 in 2022. Mortality from COVID-19 in cancer patients, which reached its peak in 2021 (6.0/100,000), was negatively associated with the density of hospital beds in the public health system. CONCLUSIONS The lower-than-expected cancer mortality during 2020-2022 seems to be partly explained by mortality from COVID-19 in cancer patients, which was probably underestimated in Brazil. The findings suggested a protective role of the availability of hospital care concerning deaths due to COVID-19 in this population. More extensive follow-up is needed to understand the impact of the COVID-19 pandemic on cancer mortality.
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Affiliation(s)
- Amanda Ramos da Cunha
- School of Public Health, University of São Paulo, 715 Doutor Arnaldo Ave, São Paulo-SP, 01246904, Brazil.
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da Silva AR, Scorzafave LGDS. Inequality by Skin Color in Breast Cancer Screening in Brazil: a Differences-in-Differences Analysis of the COVID-19 Pandemic. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01908-2. [PMID: 38228863 DOI: 10.1007/s40615-024-01908-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/28/2023] [Accepted: 01/04/2024] [Indexed: 01/18/2024]
Abstract
Breast cancer is the second most common cancer type and the first in mortality among Brazilian women. Mammograms are one of the main early diagnosis strategies. National breast cancer screening coverage is still low. Brazil's low screening coverage is due to high mammography access inequality. Skin color defines healthcare access differences. Our article explores the natural event of the COVID-19 pandemic to analyze differences in screening rates between two racial groups of women through the application of the differences in differences (DiD) estimator. The results indicate that BBI women (Black, Brown, and Indigenous Brazilian) have lower screening rates than WY women (White and Yellow) and that the pandemic reduced the difference between these two groups due to the lower number of mammograms performed by WY women. It is believed that the information channel can explain much of this result. The BA population, wealthier and more educated, may have had additional information about COVID-19 and its consequences, as well as an increased likelihood of working remotely and practicing social distance. Structural racism causes many social indicators to be correlated with inequality of access to mammography and negatively impacts health conditions for BBI women. Public policies are necessary for equal access to breast cancer screening for the most vulnerable women.
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Affiliation(s)
- Alana Ramos da Silva
- Faculty of Economics, Administration and Accounting of Ribeirão Preto, University of São Paulo (FEA-RP/USP), Ribeirão Preto, SP, Brazil.
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Teuteberg N, Barnard MM, Fernandez A, Cloete K, Mukosi M, Pitcher R. The Impact of COVID-19 on the Utilization of Public Sector Radiological Services in the Western Cape Province of South Africa. Cureus 2023; 15:e47616. [PMID: 38021905 PMCID: PMC10667617 DOI: 10.7759/cureus.47616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2023] [Indexed: 12/01/2023] Open
Abstract
Background Coronavirus (COVID-19) was officially declared a pandemic in March 2020 and has had a major impact on global healthcare services, including radiology. However, little is known about the full impact of COVID-19 on the utilization of diagnostic imaging in Africa's public healthcare sector. Objectives The objective of this study was to compare public sector diagnostic imaging utilization by modality for the whole Western Cape Province (WCP) of South Africa (SA), as well as its metropolitan and rural areas, in 2019 and 2020 in terms of the absolute number of investigations and investigations per 1000 people. Method We performed a retrospective analysis of Western Cape Government Department of Health and Wellness and Stats SA District Council 2021 Mid-Year Population Estimates data. All diagnostic imaging investigations performed in 2019 and 2020 were collated and stratified by imaging modality, geographic region (metropolitan/rural), and calendar year. Data are presented as the total number of investigations and investigations per 1000 people. We calculated mammography utilization for women aged 40-70 years and compared data for 2019 and 2020. Results Between 2019 and 2020, the provincial population increased by 1.9%, while total imaging investigations and investigations per 1000 people decreased by 19% (1,384,941 vs. 1,123,508, -261,433) and 20% (262/103 vs. 208/103), respectively. Total numerical decline was highest in plain radiographs (1,005,545 vs. 800,641, -204,904), accounting for more than three-quarters (78%) of the total reduction. Percentage decline was most pronounced for mammography, as utilization was almost halved (15.7/103 vs. 8.9/103, -43%), whereas computed tomography was the least impacted (17.9/103 vs. 16.7/103, -12%) with the remaining modalities decreasing between approximately one-quarter and one-fifth (magnetic resonance imaging = 26%, fluoroscopy = 25%, general radiographs = 23%, ultrasound = 16%, chest radiographs = 18%). Proportional metropolitan (-18.7%) and rural decreases (-19.3%) were similar. Conclusion COVID-19 had a substantial impact on WCP imaging services, decreasing overall radiological investigations by almost one-fifth. The greatest impact was on elective investigations, particularly mammography. Although the proportional impact was similar for the metropolitan and rural areas, COVID-19 nonetheless exacerbated existing discrepancies in imaging utilization between the geographical regions. The medium- and long-term clinical impacts of decreased imaging are still to be defined.
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Affiliation(s)
- Nolene Teuteberg
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, ZAF
| | - Michelle M Barnard
- Sub-Directorate Medical Imaging Services, Directorate: Health Technology, Western Cape Government Department of Health and Wellness, Cape Town, ZAF
| | - Amanda Fernandez
- Sub-Directorate Medical Imaging Services, Directorate: Health Technology, Western Cape Government Department of Health and Wellness, Cape Town, ZAF
| | - Keith Cloete
- Department of Health and Wellness, Western Cape Government, Cape Town, ZAF
| | - Matodzi Mukosi
- Department of Health and Wellness, Western Cape Government, Cape Town, ZAF
| | - Richard Pitcher
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, ZAF
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Freitas-Junior R, Rocha AFBDM, Couto HL, Bessa JDF, Urban LABD. COVID-19 and Breast Cancer Diagnosis in Brazil: An Analogy to the Sinking of the Titanic. JCO Glob Oncol 2023; 9:e2300108. [PMID: 37428993 PMCID: PMC10581622 DOI: 10.1200/go.23.00108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 04/13/2023] [Indexed: 07/12/2023] Open
Affiliation(s)
- Ruffo Freitas-Junior
- Ruffo Freitas-Junior, MD, PhD, Mastology Program, Teaching Hospital, Federal University of Goiás, Goiânia, GO, Brazil, Araújo Jorge Hospital, Goiás Anticancer Association, Goiânia, GO, Brazil; Aline Ferreira Bandeira de Melo Rocha, MD, School of Medicine, Federal University of Goiás, Goiânia, GO, Brazil; Henrique Lima Couto, MD, PhD, Redimama-Redimasto Breast Unit, Belo Horizonte, MG, Brazil; Jordana de Faria Bessa, MD, Instituto D'Or de Pesquisa e Ensino, São Paulo, SP, Brazil; and Linei Augusta Brolini Dellê Urban, MD, Member of the National Committee on Mammography of the Brazilian College of Radiology, Curitiba, PR, Brazil
| | - Aline Ferreira Bandeira de Melo Rocha
- Ruffo Freitas-Junior, MD, PhD, Mastology Program, Teaching Hospital, Federal University of Goiás, Goiânia, GO, Brazil, Araújo Jorge Hospital, Goiás Anticancer Association, Goiânia, GO, Brazil; Aline Ferreira Bandeira de Melo Rocha, MD, School of Medicine, Federal University of Goiás, Goiânia, GO, Brazil; Henrique Lima Couto, MD, PhD, Redimama-Redimasto Breast Unit, Belo Horizonte, MG, Brazil; Jordana de Faria Bessa, MD, Instituto D'Or de Pesquisa e Ensino, São Paulo, SP, Brazil; and Linei Augusta Brolini Dellê Urban, MD, Member of the National Committee on Mammography of the Brazilian College of Radiology, Curitiba, PR, Brazil
| | - Henrique Lima Couto
- Ruffo Freitas-Junior, MD, PhD, Mastology Program, Teaching Hospital, Federal University of Goiás, Goiânia, GO, Brazil, Araújo Jorge Hospital, Goiás Anticancer Association, Goiânia, GO, Brazil; Aline Ferreira Bandeira de Melo Rocha, MD, School of Medicine, Federal University of Goiás, Goiânia, GO, Brazil; Henrique Lima Couto, MD, PhD, Redimama-Redimasto Breast Unit, Belo Horizonte, MG, Brazil; Jordana de Faria Bessa, MD, Instituto D'Or de Pesquisa e Ensino, São Paulo, SP, Brazil; and Linei Augusta Brolini Dellê Urban, MD, Member of the National Committee on Mammography of the Brazilian College of Radiology, Curitiba, PR, Brazil
| | - Jordana de Faria Bessa
- Ruffo Freitas-Junior, MD, PhD, Mastology Program, Teaching Hospital, Federal University of Goiás, Goiânia, GO, Brazil, Araújo Jorge Hospital, Goiás Anticancer Association, Goiânia, GO, Brazil; Aline Ferreira Bandeira de Melo Rocha, MD, School of Medicine, Federal University of Goiás, Goiânia, GO, Brazil; Henrique Lima Couto, MD, PhD, Redimama-Redimasto Breast Unit, Belo Horizonte, MG, Brazil; Jordana de Faria Bessa, MD, Instituto D'Or de Pesquisa e Ensino, São Paulo, SP, Brazil; and Linei Augusta Brolini Dellê Urban, MD, Member of the National Committee on Mammography of the Brazilian College of Radiology, Curitiba, PR, Brazil
| | - Linei Augusta Brolini Dellê Urban
- Ruffo Freitas-Junior, MD, PhD, Mastology Program, Teaching Hospital, Federal University of Goiás, Goiânia, GO, Brazil, Araújo Jorge Hospital, Goiás Anticancer Association, Goiânia, GO, Brazil; Aline Ferreira Bandeira de Melo Rocha, MD, School of Medicine, Federal University of Goiás, Goiânia, GO, Brazil; Henrique Lima Couto, MD, PhD, Redimama-Redimasto Breast Unit, Belo Horizonte, MG, Brazil; Jordana de Faria Bessa, MD, Instituto D'Or de Pesquisa e Ensino, São Paulo, SP, Brazil; and Linei Augusta Brolini Dellê Urban, MD, Member of the National Committee on Mammography of the Brazilian College of Radiology, Curitiba, PR, Brazil
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