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. 2025 Jan;14(1):e70487.
doi: 10.1002/cam4.70487.

A Nationwide Exploration of Social Inequalities in Cancer Mortality Amidst the COVID-19 Pandemic in Belgium

Yasmine Khan  1   2   3 , Laura Van den Borre  2   3 , Delphine De Smedt  1 , Nick Verhaeghe  1 , Brecht Devleesschauwer  2   4 , Patrick Deboosere  3 , Katrien Vanthomme  1 , Sylvie Gadeyne  3
Affiliations

A Nationwide Exploration of Social Inequalities in Cancer Mortality Amidst the COVID-19 Pandemic in Belgium

Yasmine Khan et al. Cancer Med. 2025 Jan.

Abstract

Background: The COVID-19 pandemic disrupted global health systems, impacting cancer care and potentially increasing cancer mortality, especially among socioeconomically disadvantaged individuals. We aimed to assess changes in cancer mortality from March 1 to December 31, 2020 relative to the same period in 2019, and to examine potential shifts in cancer mortality's social disparities during the same time frame.

Methods: We used nationwide individually linked cancer mortality data from the Belgian National Register, the Census 2011, and the tax register. Analyses were stratified by age group (45-59 years, 60-74 years, 75+ years) and sex across all cancer types, including breast, colorectal, lung, pancreatic, and prostate. Direct age-standardized mortality rates were calculated in 2019 and 2020 to calculate absolute and relative changes in cancer mortality by social indicators. Relative inequalities in cancer mortality by social groups were calculated for both time frames using Poisson regression. Sensitivity analysis considered any mention of specified cancer groups on the Belgian death certificate.

Results: For both overall and site-specific cancers, our study found decreases in cancer mortality during the pandemic's early stages, particularly among individuals aged 75 and older. These changes did not significantly alter established socioeconomic patterns in cancer mortality.

Conclusions: Reductions in reported cancer deaths in 2020 may reflect COVID-19 prioritization in cause-of-death coding and its role as a competing risk, rather than true declines. Persistent educational disparities emphasize the need for continued policy and healthcare collaboration, with future research focused on the pandemic's long-term effects on cancer mortality and social inequalities.

Keywords: COVID‐19; cancer; mortality; social inequalities.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Education‐related cancer mortality rate ratios (MRRs) and 95% CI for all cancers (C00–C97) in 2020 and 2019, among the 45–59, 60–74, and 75+ age groups, by sex.
FIGURE 2
FIGURE 2
Education‐related cancer mortality rate ratios (MRRs) and 95% CI for breast cancer (C50) in 2020 and 2019, among women aged 45–59, 60–74, and 75+.
FIGURE 3
FIGURE 3
Education‐related cancer mortality rate ratios (MRRs) and 95% CI for colorectal cancer (C18–C20) in 2020 and 2019, among the 45–59, 60–74, and 75+ age groups, by sex.
FIGURE 4
FIGURE 4
Education‐related cancer mortality rate ratios (MRRs) and 95% CI for lung cancer (C33–C34) in 2020 and 2019, among the 45–59, 60–74, and 75+ age groups, by sex.
FIGURE 5
FIGURE 5
Education‐related cancer mortality rate ratios (MRRs) and 95% CI for pancreatic cancer (C25) in 2020 and 2019, among the 45–59, 60–74, and 75+ age groups, by sex.
FIGURE 6
FIGURE 6
Education‐related cancer mortality rate ratios (MRRs) and 95% CI for prostate cancer (C61) in 2020 and 2019, among men aged 45–59, 60–74, and 75+.
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References

    1. International Agency for Research on Cancer (IARC/WHO) , “Cancer,” (2019), https://ourworldindata.org/cancer.
    1. European Commission , “Europe's Beating Cancer Plan: Communication From the Commission to the European Parliament and the Council,” (2022), https://health.ec.europa.eu/system/files/2022‐02/eu_cancer‐plan_en_0.pdf.
    1. Lago‐Peñas S., Rivera B., Cantarero D., et al., “The Impact of Socioeconomic Position on Non‐Communicable Diseases: What Do We Know About It?,” Perspectives in Public Health 141, no. 3 (2021): 158–176. - PubMed
    1. Rosskamp M., Verbeeck J., Gadeyne S., Verdoodt F., and De Schutter H., “Socio‐Economic Position, Cancer Incidence and Stage at Diagnosis: A Nationwide Cohort Study in Belgium,” Cancers 13, no. 5 (2021): 933. - PMC - PubMed
    1. Albert‐Ballestar S. and García‐Altés A., “Measuring Health Inequalities: A Systematic Review of Widely Used Indicators and Topics,” International Journal for Equity in Health 20, no. 1 (2021): 73. - PMC - PubMed