ArticleInternational journal for equity in health2026
Mandated capacity reductions created new gender disparities in liver cancer surveillance: a population-based cohort study.
Article in International journal for equity in health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundHealthcare capacity constraints often force providers to prioritize acute conditions over preventive services such as cancer screening. However, few studies have quantified the effects of capacity-constraining policies, which is critical for emergency preparedness. We assessed how precautionary government-mandated hospital capacity reductions during the COVID-19 pandemic affected liver cancer surveillance, health equity, and clinical outcomes.
methodsWe conducted a population-based cohort study of 567,632 patients with hepatitis B/C in Taiwan’s National Health Insurance Database, using multiple-group interrupted time-series analysis (2021 vs. control period 2015–2019). The primary outcome was weekly abdominal ultrasound screening rates per 1,000 patients. A supplementary difference-in-differences analysis examined tumor size at diagnosis.
resultsAt mandate onset, the surveillance rates dropped 48.8%. Cumulative surveillance deficits reached 22.7% (95% CI, − 34.7% to − 10.7%; P < 0.001) during the mandate, disproportionately affecting women, younger adults, and non-cirrhotic patients. While disparities among younger and non-cirrhotic patients were temporary, gender disparities persisted: women experienced 1.5-fold greater declines than men during the mandate (–25.3% vs. − 17.3%; P < 0.001) and 1.3-fold greater declines post-mandate (–47.0% vs. − 37.4%; P < 0.001). Mean tumor size at diagnosis increased 5.29 mm (a 9.1% growth; P = 0.001), with greater increases among women (12.8%) than men (8.5%).
conclusionsGovernment-mandated capacity reductions, even with minimal COVID-19 caseload, led to substantial and prolonged surveillance deficits. These policies created new, persistent gender disparities and were associated with delayed cancer detection within a universal healthcare system. Crisis preparedness planning must incorporate health equity impact assessments to prevent unintended harm. Gender-sensitive strategies are urgently needed to re-engage women in preventive care.
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