Mortality trends for colorectal cancer during the COVID-19 pandemic in the US

Mortality trends for colorectal cancer during the COVID-19 pandemic in the US | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Short Report Mortality trends for colorectal cancer during the COVID-19 pandemic in the US Camilla Mattiuzzi, Giuseppe Lippi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4492773/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract It can be assumed that a reduction in patient access to colorectal cancer screening and early management during the coronavirus disease 2019 (COVID-19) pandemic could have generated a negative impact on subsequent diagnoses and survival probabilities. We report here the recent statistics on colorectal cancer-related deaths in the US. We searched the CDC online database WONDER database, which reports mortality data for the entire country, using specific ICD-10 codes for colorectal cancer (from C18 to C20). The age-adjusted death rate ×100,000 for colorectal cancer displayed a gradual decrease from 2018 (13.06) to 2019 (12.76) and 2020 (12.55), but then reversed in 2021, when the age-adjusted death rate increased to 12.94, decreasing to 12.58 in 2022 and increasing again to 12.75 in 2023. The results of our analysis suggest that the COVID-19 pandemic has likely had a negative impact on early mortality from colorectal cancer, as shown by the significant increase in the age-adjusted death rate recorded in 2021. Mortality Medical Errors Colorectal cancer Figures Figure 1 Full Text There are now several pieces of evidence that the harm caused by coronavirus disease 2019 (COVID-19) goes beyond an immediate organic damage, but may generate a variety of additional “collateral” damages. This last category of health problems includes delays in diagnosis due to social isolation measures (e.g. home segregation, lockdowns and curfews), as well as to the fear of going to crowded places such as hospitals and the resulting backlog of patients, which have caused a significant impact on population screening, including colorectal cancer screening during the early period of the pandemic (1). In particular, a recently published article by Brenner et al. showed a remarkable decrease in colorectal cancer diagnoses in Saarland/Germany during the COVID-19 pandemic until the second quarter of 2021 (2). These results overlap with those published in the US, where, it was estimated that colorectal cancer screenings decreased by around 85% in the early phase of the COVID-19 pandemic (3). Therefore, it would be expected that such a reduction in patient access to colorectal cancer screening could have generated a negative impact on subsequent diagnoses and survival probabilities. To this end, we report here the recent statistics on colorectal cancer-related deaths in the US. We electronically searched the latest updated version of the US Centers for Disease Control and Prevention (CDC) online database WONDER (Provisional Multiple Cause of Death Data; years 2018-2023), which reports mortality data for the entire country. Data originate from death certificates for US residents (with a single underlying cause of death and demographic data). Our search was performed with “year” as the first variable (from 2018 to 2023) and specific ICD-10 codes for colorectal cancer as the second variable (from C18 to C20). Mortality data were expressed as age-adjusted death rates (×100,000) and their relative 95% confidence interval (95%CI). Values were analyzed with one-way analysis of variance (ANOVA) and Tukey post-hoc test. The study was conducted in accordance with the Declaration of Helsinki and in accordance with the terms of the relevant local legislation. The results of our search in the CDC WONDER online database (years 2018-2021) are summarized in Figure 1. The age-adjusted death rate for colorectal cancer displayed a gradual decrease from 2018 (13.06×100,000; 95%CI, 12.95-13.18×100,000) to 2019 (12.76×100,000; 95%CI, 12.64-12.87×100,000) and 2020 (12.55×100,000; 95%CI, 12.44-12.66×100,000). This favorable trend was then reversed in 2021, when the age-adjusted death rate for colorectal cancer increased to 12.94×100,000 (95%CI, 12.83-13.06×100,000), decreasing to 12.58×100,000 (95%CI, 12.47-12.68) in 2022 and increasing again to 12.75×100,000 (95%CI, 12.64-12.86×100,000) in 2023. The variation throughout the observation period was statistically significant (f=12.20; p<0.001). In Tukey Post-hoc Test, the reduction observed in 2019 (p=0.003) and 2020 (p<0.001) was statistically significant compared to the year 2018, while the increase observed in 2021 was statistically significant compared to the year 2020 (p<0.001). The further reduction observed in 2022 was then statistically significant compared to the year 2021 (p<0.001). A statistically significant reduction was also observed in 2022 (p<0.001) and 2023 (p=0.001) compared to the year 2018. No other statistically significant differences could be seen across other years comparisons. The results of our analysis of the CDC-WONDER online database show that the COVID-19 pandemic has likely had a negative impact on early mortality from colorectal cancer, as shown by the significant increase in the age-adjusted death rate recorded in 2021, reversing the otherwise favorable downward trend of the previous three years. A further, although not yet statistically significant (p=0.272), increase was recorded between the years 2022 and 2023, which needs to be monitored closely as it may reflect a second peak of late colorectal cancer mortality due to delayed diagnosis of a number of patients with curable disease. Declarations Author contributions Conceptualization and study design: CM and GL. Statistical analysis: GL. Drafting of manuscript: GL. Review and revision: all authors. Final approval: all authors. Funding No financial disclosures were reported by the authors of this paper. Data Availability The data that support the findings of this study are available from the corresponding author upon reasonable request. Ethical approval This is an observational study using a freely available online database. No ethical approval is required. Conflict of interest None of the authors have funding sources or institutional and corporate affiliations that supported this work. Grant support Not applicable. Writing assistance Not applicable. References Kadakuntla A, Wang T, Medgyesy K, et al. Colorectal cancer screening in the COVID-19 era. World J Gastrointest Oncol. 2021;13(4):238–51. Brenner H, Weber L, Cardoso R, Heisser T, Hoffmeister M, Holleczek B. Indications of sustained delay of colorectal cancer diagnoses in Germany during the first 2 years of the COVID-19 pandemic. Int J Cancer. 2024 Apr;1. 10.1002/ijc.34943 . Epub ahead of print. London JW, Fazio-Eynullayeva E, Palchuk MB, Sankey P, McNair C. Effects of the COVID-19 Pandemic on Cancer-Related Patient Encounters. JCO Clin Cancer Inf. 2020;4:657–65. Centers for Disease Control and Prevention, National Center for Health Statistics. National Vital Statistics System, Provisional Mortality on CDC WONDER Online Database. Data are from the final Multiple Cause of Death Files, 2018–2021, and from provisional data for years 2022–2024, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/mcd-icd10-provisional.html on Apr 2, 2024. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4492773","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Short Report","associatedPublications":[],"authors":[{"id":309975173,"identity":"2283ffec-b241-4402-90e1-1d966faa4964","order_by":0,"name":"Camilla Mattiuzzi","email":"","orcid":"","institution":"Rovereto Hospital, Provincial Agency for Social and Sanitary Services (APSS)","correspondingAuthor":false,"prefix":"","firstName":"Camilla","middleName":"","lastName":"Mattiuzzi","suffix":""},{"id":309975174,"identity":"88d63b89-a157-4165-857d-c8fde6bff1a4","order_by":1,"name":"Giuseppe Lippi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8UlEQVRIie3RMQrCMBSA4VcetEvEWUR7hZRAJ3H1Gi2CcydXC4U4iaveouCgbpWsogfQTehccRIqGLQVHVIdHfIPoQl8vIQC6HT/GJYflhEC0E5xQn8h+CCDklSZTyvKrZrYPcKy8+rYBkR+CoK9v7SIm0GQK4kjiNuYb1MmLzZmM3rw1xFhs6qLORFxscaFH6LBm0SSWJj9yrdIwi43LkYF2X0nNhLaNLjw4EkSSVBUEormsDHZpg5/vqXPHsSjTD1lKhbZdXW069Y4PQV5txXvNxFkeVs9JZGLESZgApiv3wqeEsgpYUHgg+h0Op3urTs0H0uNlvuPSAAAAABJRU5ErkJggg==","orcid":"","institution":"University of Verona","correspondingAuthor":true,"prefix":"","firstName":"Giuseppe","middleName":"","lastName":"Lippi","suffix":""}],"badges":[],"createdAt":"2024-05-28 18:56:35","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4492773/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4492773/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":58247902,"identity":"bbd19aa6-f893-467d-bc33-54cf7a31790d","added_by":"auto","created_at":"2024-06-13 02:43:16","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":152108,"visible":true,"origin":"","legend":"\u003cp\u003eMortality for colorectal cancer in the US during the period 2018-2023, as retrievable from the US Centers for Disease Control and Prevention (CDC) WONDER online database. Data are expressed as age-adjusted death rate ×100,000.\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4492773/v1/c57c564a87314b2bb970bef0.jpg"},{"id":59884943,"identity":"2d8ec9fa-45e0-496f-9a6f-7b8a3129ed46","added_by":"auto","created_at":"2024-07-09 00:01:40","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":311724,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4492773/v1/82fe422e-ecfa-43ea-9327-89f9493efaeb.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Mortality trends for colorectal cancer during the COVID-19 pandemic in the US","fulltext":[{"header":"Full Text","content":"\u003cp\u003eThere are now several pieces of evidence that the harm caused by coronavirus disease 2019 (COVID-19) goes beyond an immediate organic damage, but may generate a variety of additional \u0026ldquo;collateral\u0026rdquo; damages. This last category of health problems includes delays in diagnosis due to social isolation measures (e.g. home segregation, lockdowns and curfews), as well as to the fear of going to crowded places such as hospitals and the resulting backlog of patients, which have caused a significant impact on population screening, including colorectal cancer screening during the early period of the pandemic (1). In particular, a recently published article by Brenner et al. showed a remarkable decrease in colorectal cancer diagnoses in Saarland/Germany during the COVID-19 pandemic until the second quarter of 2021 (2).\u0026nbsp;These results overlap with those published in the US, where, it was estimated that colorectal cancer screenings decreased by around 85% in the early phase of the COVID-19 pandemic (3). Therefore, it would be expected that such a reduction in patient access to colorectal cancer screening could have generated a negative impact on subsequent diagnoses and survival probabilities. To this end, we report here the recent statistics on colorectal cancer-related deaths in the US.\u003c/p\u003e\n\u003cp\u003eWe electronically searched the latest updated version of the US Centers for Disease Control and Prevention (CDC) online database WONDER (Provisional Multiple Cause of Death Data; years 2018-2023), which reports mortality data for the entire country. Data originate from death certificates for US residents (with a single underlying cause of death and demographic data). Our search was performed with \u0026ldquo;year\u0026rdquo; as the first variable (from 2018 to 2023) and specific ICD-10 codes for colorectal cancer as the second variable (from C18 to C20). Mortality data were expressed as age-adjusted death rates (\u0026times;100,000) and their relative 95% confidence interval (95%CI). Values were analyzed with one-way analysis of variance (ANOVA) and Tukey post-hoc test. The study was conducted in accordance with the Declaration of Helsinki and in accordance with the terms of the relevant local legislation.\u003c/p\u003e\n\u003cp\u003eThe results of our search in the CDC WONDER online database (years 2018-2021) are summarized in Figure 1. The age-adjusted death rate for colorectal cancer displayed a gradual decrease from 2018 (13.06\u0026times;100,000; 95%CI, 12.95-13.18\u0026times;100,000) to 2019 (12.76\u0026times;100,000; 95%CI, 12.64-12.87\u0026times;100,000) and 2020 (12.55\u0026times;100,000; 95%CI, 12.44-12.66\u0026times;100,000). This favorable trend was then reversed in \u0026nbsp;2021, when the age-adjusted death rate for colorectal cancer increased to 12.94\u0026times;100,000 (95%CI, 12.83-13.06\u0026times;100,000), decreasing to 12.58\u0026times;100,000 (95%CI, 12.47-12.68) in 2022 and increasing again to 12.75\u0026times;100,000 (95%CI, 12.64-12.86\u0026times;100,000) in 2023. The variation throughout the observation period was statistically significant (f=12.20; p\u0026lt;0.001). In Tukey Post-hoc Test, the reduction observed in 2019 (p=0.003) and 2020 (p\u0026lt;0.001) was statistically significant compared to the year 2018, while the increase observed in 2021 was statistically significant compared to the year 2020 (p\u0026lt;0.001). The further reduction observed in 2022 was then statistically significant compared to the year 2021 (p\u0026lt;0.001).\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;A statistically significant reduction was also observed in 2022 (p\u0026lt;0.001) and 2023 (p=0.001) compared to the year 2018. No other statistically significant differences could be seen across other years comparisons.\u003c/p\u003e\n\u003cp\u003eThe results of our analysis of the CDC-WONDER online database show that the COVID-19 pandemic has likely had a negative impact on early mortality from colorectal cancer, as shown by the significant increase in the age-adjusted death rate recorded in 2021, reversing the otherwise favorable downward trend of the previous three years. A further, although not yet statistically significant (p=0.272), increase was recorded between the years 2022 and 2023, which needs to be monitored closely as it may reflect a second peak of late colorectal cancer mortality due to delayed diagnosis of a number of patients with curable disease.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization and study design: CM and GL. Statistical analysis: GL. Drafting of manuscript: GL. Review and revision: all authors. Final approval: all authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo financial disclosures were reported by the authors of this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u0026nbsp;\u003c/strong\u003eThis is an observational study using a freely available online database. No ethical approval is required.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone of the authors have funding sources or institutional\u0026nbsp;and corporate affiliations that supported this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGrant support\u003c/strong\u003e Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWriting assistance\u003c/strong\u003e Not applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKadakuntla A, Wang T, Medgyesy K, et al. Colorectal cancer screening in the COVID-19 era. World J Gastrointest Oncol. 2021;13(4):238\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrenner H, Weber L, Cardoso R, Heisser T, Hoffmeister M, Holleczek B. Indications of sustained delay of colorectal cancer diagnoses in Germany during the first 2 years of the COVID-19 pandemic. Int J Cancer. 2024 Apr;1. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/ijc.34943\u003c/span\u003e\u003cspan address=\"10.1002/ijc.34943\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub ahead of print.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLondon JW, Fazio-Eynullayeva E, Palchuk MB, Sankey P, McNair C. Effects of the COVID-19 Pandemic on Cancer-Related Patient Encounters. JCO Clin Cancer Inf. 2020;4:657\u0026ndash;65.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCenters for Disease Control and Prevention, National Center for Health Statistics. National Vital Statistics System, Provisional Mortality on CDC WONDER Online Database. Data are from the final Multiple Cause of Death Files, 2018\u0026ndash;2021, and from provisional data for years 2022\u0026ndash;2024, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://wonder.cdc.gov/mcd-icd10-provisional.html\u003c/span\u003e\u003cspan address=\"http://wonder.cdc.gov/mcd-icd10-provisional.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e on Apr 2, 2024.\u003c/span\u003e\u003c/li\u003e \u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Mortality, Medical Errors, Colorectal cancer","lastPublishedDoi":"10.21203/rs.3.rs-4492773/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4492773/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"It can be assumed that a reduction in patient access to colorectal cancer screening and early management during the coronavirus disease 2019 (COVID-19) pandemic could have generated a negative impact on subsequent diagnoses and survival probabilities. We report here the recent statistics on colorectal cancer-related deaths in the US. We searched the CDC online database WONDER database, which reports mortality data for the entire country, using specific ICD-10 codes for colorectal cancer (from C18 to C20). The age-adjusted death rate ×100,000 for colorectal cancer displayed a gradual decrease from 2018 (13.06) to 2019 (12.76) and 2020 (12.55), but then reversed in 2021, when the age-adjusted death rate increased to 12.94, decreasing to 12.58 in 2022 and increasing again to 12.75 in 2023. The results of our analysis suggest that the COVID-19 pandemic has likely had a negative impact on early mortality from colorectal cancer, as shown by the significant increase in the age-adjusted death rate recorded in 2021.","manuscriptTitle":"Mortality trends for colorectal cancer during the COVID-19 pandemic in the US","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-13 02:43:11","doi":"10.21203/rs.3.rs-4492773/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5e88a572-9ab3-4024-9419-aa066bdd5fd5","owner":[],"postedDate":"June 13th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-07-08T23:53:25+00:00","versionOfRecord":[],"versionCreatedAt":"2024-06-13 02:43:11","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4492773","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4492773","identity":"rs-4492773","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}