Extended Data Fig. 7: Forest plot of pooled rate ratios for the stage at diagnosis of cancer before and during the COVID-19 pandemic.
Two-tailed Z-scores, following a natural logarithmic transformation were used to calculate p-values, with the DerSimonian and Laird method being used to pool effect estimates. The square box represents rate ratio (RR) and the size of the box represents study weight. Diamond represents pooled RR. Dotted vertical line represents line of overall effect. Horizontal bars indicate 95% CIs of two-sided random effects meta-analyses. Vertical solid black line represents the line of no effect. Results are from pooled analyses from 80 studies with a combined cohort of 174,343 individuals. a The results showed decline in patients diagnosed with cancer at any stage in all continents. This decrease was lowest in medium HDI countries (65.0% in non-metastatic cancers vs 67.0% in metastatic cancers) compared to high HDI (45.0% in non-metastatic cancers vs 25.0% in metastatic cancers) and very high HDI countries (12.0% in non-metastatic cancers vs 10.0% in metastatic cancers). b There was an overall decrease in the number of patients newly diagnosed with both non-metastatic and metastatic cancer (RR = 0.80; 95% CI: 0.77 to 0.83) with significant heterogeneity between studies (I2 = 86.9%, P < 0.01). In the sub-group analysis comparing between continents, significant reductions in newly diagnosed non-metastatic cancers were seen in Americas (RR = 0.75; 95% CI: 0.66 to 0.85), Asia (RR = 0.82; 95% CI: 0.72 to 0.93), and Europe (RR = 0.80; 95% CI: 0.77 to 0.84). The decrease in newly diagnosed metastatic cancers was significant only in Europe (RR = 0.86; 95% CI: 0.77 to 0.96). c The decrease in the number of patients newly diagnosed with non-metastatic cancer (RR = 0.79; 95% CI: 0.75 to 0.82) was higher than the number of patients newly diagnosed with metastatic cancer (RR = 0.86; 95% CI: 0.79 to 0.94) with significant heterogeneity between studies (I2 = 74.5%, P = 0.05).
