Impact of COVID-19 pandemic on surgical cancer care disparities according to socioeconomic status

R M G van Vuren; R van den Hoek; S Kruijff; D J Heineman; N F M Kok; R J Swijnenburg; M R Visser; S S Gisbertz; T E Hendriks; J de Vos-Geelen; W Y van der Plas; M W J M Wouters

doi:10.1016/j.puhip.2026.100818

Impact of COVID-19 pandemic on surgical cancer care disparities according to socioeconomic status

R M G van Vuren
, R van den Hoek
, S Kruijff
, D J Heineman
, N F M Kok
, R J Swijnenburg
, M R Visser
, S S Gisbertz
, T E Hendriks
, J de Vos-Geelen
, W Y van der Plas
, M W J M Wouters^*

^*Corresponding author for this work

Department of Surgical Oncology

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

OBJECTIVES: This study aimed to examine whether healthcare scarcity during the COVID-19 pandemic amplified prior socioeconomic disparities in access to Dutch surgical cancer care.

STUDY DESIGN: Retrospective population-based cohort study.

METHODS: Patients who underwent surgery for lung, oesophageal, gastric, pancreatic, or malignant liver tumours were identified in national quality of care registries. A pandemic cohort (15-03-2020 to 24-04-2022) was compared with a pre-pandemic cohort (2018-2019). Socioeconomic status (SES) was based on postal-code-level scores. Primary outcome was the difference in SES distribution between cohorts. Secondary outcomes were time to treatment and likelihood of stage III disease. Multivariate logistic regression incorporated all variables associated with tumour stage.

RESULTS: A total of 29,792 procedures were analysed (14,208 pandemic; 15,584 pre-pandemic). SES distribution was similar between periods (median 0.057 vs 0.059, p = 0.7). Median time to treatment was 27 days in both cohorts (p = 0.10) with no SES-related differences. Rates of surgery for stage III were comparable across SES groups. Adjusted analyses showed no association between SES and tumour stage in either cohort (pandemic aOR 0.88, 95% CI 0.74-1.03).

CONCLUSIONS: Despite pressure on healthcare during the pandemic, access to surgical cancer care remained equitable across SES groups in the Netherlands.

Original language	English
Article number	100818
Journal	Public health in practice
Volume	12
Early online date	3 Jun 2026
DOIs	https://doi.org/10.1016/j.puhip.2026.100818
Publication status	E-pub ahead of print - 3 Jun 2026

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1-s2.0-S2666535226000972-mainFinal published version, 1.53 MBLicence: CC BY

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van Vuren, R. M. G., van den Hoek, R., Kruijff, S., Heineman, D. J., Kok, N. F. M., Swijnenburg, R. J., Visser, M. R., Gisbertz, S. S., Hendriks, T. E., de Vos-Geelen, J., van der Plas, W. Y., & Wouters, M. W. J. M. (2026). Impact of COVID-19 pandemic on surgical cancer care disparities according to socioeconomic status. Public health in practice, 12, Article 100818. Advance online publication. https://doi.org/10.1016/j.puhip.2026.100818

@article{a20eead5bc6d4b678f45c8aa36e3dd55,

title = "Impact of COVID-19 pandemic on surgical cancer care disparities according to socioeconomic status",

abstract = "OBJECTIVES: This study aimed to examine whether healthcare scarcity during the COVID-19 pandemic amplified prior socioeconomic disparities in access to Dutch surgical cancer care.STUDY DESIGN: Retrospective population-based cohort study.METHODS: Patients who underwent surgery for lung, oesophageal, gastric, pancreatic, or malignant liver tumours were identified in national quality of care registries. A pandemic cohort (15-03-2020 to 24-04-2022) was compared with a pre-pandemic cohort (2018-2019). Socioeconomic status (SES) was based on postal-code-level scores. Primary outcome was the difference in SES distribution between cohorts. Secondary outcomes were time to treatment and likelihood of stage III disease. Multivariate logistic regression incorporated all variables associated with tumour stage.RESULTS: A total of 29,792 procedures were analysed (14,208 pandemic; 15,584 pre-pandemic). SES distribution was similar between periods (median 0.057 vs 0.059, p = 0.7). Median time to treatment was 27 days in both cohorts (p = 0.10) with no SES-related differences. Rates of surgery for stage III were comparable across SES groups. Adjusted analyses showed no association between SES and tumour stage in either cohort (pandemic aOR 0.88, 95\% CI 0.74-1.03).CONCLUSIONS: Despite pressure on healthcare during the pandemic, access to surgical cancer care remained equitable across SES groups in the Netherlands.",

author = "\{van Vuren\}, \{R M G\} and \{van den Hoek\}, R and S Kruijff and Heineman, \{D J\} and Kok, \{N F M\} and Swijnenburg, \{R J\} and Visser, \{M R\} and Gisbertz, \{S S\} and Hendriks, \{T E\} and \{de Vos-Geelen\}, J and \{van der Plas\}, \{W Y\} and Wouters, \{M W J M\}",

note = "Publisher Copyright: {\textcopyright} 2026 The Authors.",

year = "2026",

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doi = "10.1016/j.puhip.2026.100818",

language = "English",

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van Vuren, RMG, van den Hoek, R, Kruijff, S, Heineman, DJ, Kok, NFM, Swijnenburg, RJ, Visser, MR, Gisbertz, SS, Hendriks, TE, de Vos-Geelen, J, van der Plas, WY & Wouters, MWJM 2026, 'Impact of COVID-19 pandemic on surgical cancer care disparities according to socioeconomic status', Public health in practice, vol. 12, 100818. https://doi.org/10.1016/j.puhip.2026.100818

TY - JOUR

T1 - Impact of COVID-19 pandemic on surgical cancer care disparities according to socioeconomic status

AU - van Vuren, R M G

AU - van den Hoek, R

AU - Kruijff, S

AU - Heineman, D J

AU - Kok, N F M

AU - Swijnenburg, R J

AU - Visser, M R

AU - Gisbertz, S S

AU - Hendriks, T E

AU - de Vos-Geelen, J

AU - van der Plas, W Y

AU - Wouters, M W J M

PY - 2026/6/3

Y1 - 2026/6/3

N2 - OBJECTIVES: This study aimed to examine whether healthcare scarcity during the COVID-19 pandemic amplified prior socioeconomic disparities in access to Dutch surgical cancer care.STUDY DESIGN: Retrospective population-based cohort study.METHODS: Patients who underwent surgery for lung, oesophageal, gastric, pancreatic, or malignant liver tumours were identified in national quality of care registries. A pandemic cohort (15-03-2020 to 24-04-2022) was compared with a pre-pandemic cohort (2018-2019). Socioeconomic status (SES) was based on postal-code-level scores. Primary outcome was the difference in SES distribution between cohorts. Secondary outcomes were time to treatment and likelihood of stage III disease. Multivariate logistic regression incorporated all variables associated with tumour stage.RESULTS: A total of 29,792 procedures were analysed (14,208 pandemic; 15,584 pre-pandemic). SES distribution was similar between periods (median 0.057 vs 0.059, p = 0.7). Median time to treatment was 27 days in both cohorts (p = 0.10) with no SES-related differences. Rates of surgery for stage III were comparable across SES groups. Adjusted analyses showed no association between SES and tumour stage in either cohort (pandemic aOR 0.88, 95% CI 0.74-1.03).CONCLUSIONS: Despite pressure on healthcare during the pandemic, access to surgical cancer care remained equitable across SES groups in the Netherlands.

AB - OBJECTIVES: This study aimed to examine whether healthcare scarcity during the COVID-19 pandemic amplified prior socioeconomic disparities in access to Dutch surgical cancer care.STUDY DESIGN: Retrospective population-based cohort study.METHODS: Patients who underwent surgery for lung, oesophageal, gastric, pancreatic, or malignant liver tumours were identified in national quality of care registries. A pandemic cohort (15-03-2020 to 24-04-2022) was compared with a pre-pandemic cohort (2018-2019). Socioeconomic status (SES) was based on postal-code-level scores. Primary outcome was the difference in SES distribution between cohorts. Secondary outcomes were time to treatment and likelihood of stage III disease. Multivariate logistic regression incorporated all variables associated with tumour stage.RESULTS: A total of 29,792 procedures were analysed (14,208 pandemic; 15,584 pre-pandemic). SES distribution was similar between periods (median 0.057 vs 0.059, p = 0.7). Median time to treatment was 27 days in both cohorts (p = 0.10) with no SES-related differences. Rates of surgery for stage III were comparable across SES groups. Adjusted analyses showed no association between SES and tumour stage in either cohort (pandemic aOR 0.88, 95% CI 0.74-1.03).CONCLUSIONS: Despite pressure on healthcare during the pandemic, access to surgical cancer care remained equitable across SES groups in the Netherlands.

U2 - 10.1016/j.puhip.2026.100818

DO - 10.1016/j.puhip.2026.100818

M3 - Article

C2 - 42358902

SN - 2666-5352

VL - 12

JO - Public health in practice

JF - Public health in practice

M1 - 100818

ER -

Impact of COVID-19 pandemic on surgical cancer care disparities according to socioeconomic status

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