PDF(Pubmed)
Abstract：
OBJECTIVE: To investigate the effect of the COVID-19 pandemic on prostate cancer incidence, prevalence, and mortality in England.
METHODS: With the approval of NHS England and using the OpenSAFELY-TPP dataset of 24 million patients, we undertook a cohort study of men diagnosed with prostate cancer. We visualised monthly rates in prostate cancer incidence, prevalence, and mortality per 100 000 adult men from January 2015 to July 2023. To assess the effect of the pandemic, we used generalised linear models and the pre-pandemic data to predict the expected rates from March 2020 as if the pandemic had not occurred. The 95% confidence intervals (CIs) of the predicted values were used to estimate the significance of the difference between the predicted and observed rates.
RESULTS: In 2020, there was a drop in recorded incidence by 4772 (31%) cases (15 550 vs 20 322; 95% CI 19 241-21 403). In 2021, the incidence started to recover, and the drop was 3148 cases (18%, 17 950 vs 21 098; 95% CI 19 740-22 456). By 2022, the incidence returned to the levels that would be expected. During the pandemic, the age at diagnosis shifted towards older men. In 2020, the average age was 71.6 (95% CI 71.5-71.8) years, in 2021 it was 71.8 (95% CI 71.7-72.0) years as compared to 71.3 (95% CI 71.1-71.4) years in 2019.
CONCLUSIONS: Given that our dataset represents 40% of the population, we estimate that proportionally the pandemic led to 20 000 missed prostate cancer diagnoses in England alone. The increase in incidence recorded in 2023 was not enough to account for the missed cases. The prevalence of prostate cancer remained lower throughout the pandemic than expected. As the recovery efforts continue, healthcare should focus on finding the men who were affected. The research should focus on investigating the potential harms to men diagnosed at older age.
METHODS: With the approval of NHS England and using the OpenSAFELY-TPP dataset of 24 million patients, we undertook a cohort study of men diagnosed with prostate cancer. We visualised monthly rates in prostate cancer incidence, prevalence, and mortality per 100 000 adult men from January 2015 to July 2023. To assess the effect of the pandemic, we used generalised linear models and the pre-pandemic data to predict the expected rates from March 2020 as if the pandemic had not occurred. The 95% confidence intervals (CIs) of the predicted values were used to estimate the significance of the difference between the predicted and observed rates.
RESULTS: In 2020, there was a drop in recorded incidence by 4772 (31%) cases (15 550 vs 20 322; 95% CI 19 241-21 403). In 2021, the incidence started to recover, and the drop was 3148 cases (18%, 17 950 vs 21 098; 95% CI 19 740-22 456). By 2022, the incidence returned to the levels that would be expected. During the pandemic, the age at diagnosis shifted towards older men. In 2020, the average age was 71.6 (95% CI 71.5-71.8) years, in 2021 it was 71.8 (95% CI 71.7-72.0) years as compared to 71.3 (95% CI 71.1-71.4) years in 2019.
CONCLUSIONS: Given that our dataset represents 40% of the population, we estimate that proportionally the pandemic led to 20 000 missed prostate cancer diagnoses in England alone. The increase in incidence recorded in 2023 was not enough to account for the missed cases. The prevalence of prostate cancer remained lower throughout the pandemic than expected. As the recovery efforts continue, healthcare should focus on finding the men who were affected. The research should focus on investigating the potential harms to men diagnosed at older age.
摘要：
目的：研究COVID-19大流行对前列腺癌发病率的影响，患病率,和英国的死亡率。
方法：经英国NHS批准，并使用2400万患者的OpenSAFELY-TPP数据集，我们对被诊断为前列腺癌的男性进行了一项队列研究.我们可视化了前列腺癌的每月发病率，患病率,2015年1月至2023年7月，每10万名成年男子的死亡率。为了评估大流行的影响，我们使用广义线性模型和大流行前数据来预测从2020年3月起的预期发病率,就好像大流行没有发生.预测值的95%置信区间(CI)用于估计预测率和观察率之间差异的显著性。
结果：在2020年，记录的发病率下降了4772例（31％）（15550对20322；95％CI19241-21403）。在2021年，发病率开始恢复，下降了3148例(18%，17950对21098；95%CI19740-22456）。到2022年，发病率恢复到预期水平。大流行期间,诊断的年龄转向老年男性。2020年，平均年龄为71.6(95%CI71.5-71.8)岁，2021年为71.8年（95%CI71.7-72.0年），而2019年为71.3年（95%CI71.1-71.4年）。
结论：鉴于我们的数据集代表了40%的人口，我们估计，仅在英格兰，大流行就导致20000例前列腺癌漏诊。2023年记录的发病率增加不足以解释漏诊病例。在整个大流行期间，前列腺癌的患病率仍然低于预期。随着恢复努力的继续，医疗保健应该专注于寻找受影响的男性。该研究应侧重于调查对老年男性的潜在危害。
方法：经英国NHS批准，并使用2400万患者的OpenSAFELY-TPP数据集，我们对被诊断为前列腺癌的男性进行了一项队列研究.我们可视化了前列腺癌的每月发病率，患病率,2015年1月至2023年7月，每10万名成年男子的死亡率。为了评估大流行的影响，我们使用广义线性模型和大流行前数据来预测从2020年3月起的预期发病率,就好像大流行没有发生.预测值的95%置信区间(CI)用于估计预测率和观察率之间差异的显著性。
结果：在2020年，记录的发病率下降了4772例（31％）（15550对20322；95％CI19241-21403）。在2021年，发病率开始恢复，下降了3148例(18%，17950对21098；95%CI19740-22456）。到2022年，发病率恢复到预期水平。大流行期间,诊断的年龄转向老年男性。2020年，平均年龄为71.6(95%CI71.5-71.8)岁，2021年为71.8年（95%CI71.7-72.0年），而2019年为71.3年（95%CI71.1-71.4年）。
结论：鉴于我们的数据集代表了40%的人口，我们估计，仅在英格兰，大流行就导致20000例前列腺癌漏诊。2023年记录的发病率增加不足以解释漏诊病例。在整个大流行期间，前列腺癌的患病率仍然低于预期。随着恢复努力的继续，医疗保健应该专注于寻找受影响的男性。该研究应侧重于调查对老年男性的潜在危害。
