Relationship between COVID-19 pandemic and early mortality for malignant prostate cancer

Coronavirus disease 2019 (COVID-19) has generated both direct and indirect health harm to single individuals and communities worldwide, especially during the first period of the pandemic. In particular, recent evidence has been provided that the COVID-19 pandemic has concomitantly led to a reduction in the number of diagnoses of prostate cancer, and increased evidence in more advanced in those who were diagnosed with this malignancy (1). To this end we plan this epidemiological study to investigate whether missed screening opportunities during the COVID-19 pandemic may have influenced early prostate cancer-related deaths in the US.

We performed an electronic search in the most frequently updated US Centers for Disease Control and Prevention (CDC)-WONDER online database (years 2018–2022) (2), which reports mortality data for the entire country stratified by various causes, regions, times and demographic variables. The data contained in this online database are derived from death certificates for US residents with single underlying cause of death. We performed the search using “year” as the first variable (from 2018 to 2022) and the specific ICD-10 code for malignant prostate cancer as the second variable (C61: malignant neoplasm of prostate). Mortality for malignant prostate cancer was expressed as age-adjusted death rate (×100,000) and 95% confidence interval (95% CI), and statistically analyzed using one-way analysis of variance (ANOVA) and Tukey post-hoc test. According to the WONDER database, age-adjusts death rates are calculated using a direct approach, i.e., applying age-specific death rates (“Ri”) to U.S. standard population age distribution, with the formula [R’] = [Ʃi (Psi/Ps) Ri], where “Psi” stands for the standard population for age group “i”, and “Ps” stands for the total U.S. standard population of all ages. The study was conducted on open source data, in accordance with the Declaration of Helsinki and in accordance with the terms of the relevant local legislation. This study was exempt from Institutional Review Board review as the CDC-WONDER is an anonymized freely available database.

The results of electronic our search in the 2018–2021 CDC-WONDER online database are shown in Figure 1. The age-adjusted death rate ×100,000 for malignant prostate cancer decreased from 2018 (7.84, 95% CI: 7.75–7.93) to 2019 (7.68, 95% CI: 7.59–7.76), but then gradually increased in 2020 (7.76, 95% CI: 7.68–7.85), 2021 (7.98, 95% CI: 7.89–8.06), and decreased again in 2022 (7.75, 95% CI: 7.66–7.83). The variation of the age-adjusted mortality for malignant prostate cancer was statistically significant by ANOVA throughout 2018–2022 (f=6.61; P<0.001). In Tukey Post-hoc Test, the increase in mortality for malignant prostate cancer was significant between the years 2021 and 2019 (P<0.001), between the years 2021 and 2020 (P=0.003), and between the years 2022 and 2021 (P=0.002). The multiple comparisons between all possible pairs of each of the other years included in our analysis failed to reveal significant differences.

Figure 1 Mortality for malignant prostate cancer in the US during the period 2018–2022, retrieved from the US CDC-WONDER online database. Data are expressed as age-adjusted death rate ×100,000. CDC, Centers for Disease Control and Prevention.

The results of this electronic search of the 2018–2022 CDC-WONDER online database show that there was an increase in malignant prostate cancer-related mortality during the first two years of the COVID-19 pandemic, a stark contrast to the improving trend in mortality in the prior years. This trend was however reversed in 2022, as the age-adjusted mortality returned to values compared to the pre-pandemic period. The reasons for such an early increase in prostate cancer deaths are many and multifaceted, including missed screening opportunities, delayed diagnosis and treatment due to reduced access to healthcare, along with the negative impact that COVID-19 may have generated on healthcare resources. Nevertheless, several additional years of mortality data will be needed to have a complete picture besides the increase of “early mortality” for prostate cancer reported in our study.

Acknowledgments

Funding: None.

Footnote

Provenance and Peer Review: This article was a standard submission to the journal. The article has undergone external peer review.

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Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at https://ace.amegroups.com/article/view/10.21037/ace-24-9/coif). The authors have no conflicts of interest to declare.

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References

1. Nossiter J, Morris M, Parry MG, et al. Impact of the COVID-19 pandemic on the diagnosis and treatment of men with prostate cancer. BJU Int 2022;130:262-70. [Crossref] [PubMed]
2. Centers for Disease Control and Prevention, National Center for Health Statistics. National Vital Statistics System, Mortality 2018-2022 on CDC WONDER Online Database, released in 2024. Data are from the Multiple Cause of Death Files, 2018-2022, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed online: http://wonder.cdc.gov/ucd-icd10-expanded.html