Mandated capacity reductions created new gender disparities in liver cancer surveillance: a population-based cohort study

Healthcare 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. We 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. At 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%). Government-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.