{
  "abstract": "Background Emergency policies designed to protect populations can inadvertently cause diagnostic harm when essential services are suspended. How such policies reshape gender gaps in cancer detection, and whether either sex faces disproportionate harm, remains underexplored.Objectives We leveraged Taiwan’s 2021 level 3 alert—a precautionary directive implemented during minimal COVID-19 transmission (0.07%) that mandated hospital capacity reductions and school closures—as a natural experiment to test whether the alert produced gendered diagnostic disruptions.Methods Using Taiwan Cancer Registry and National Health Insurance claims (N=312 522; 2015–2021), we employed interrupted time series and difference-in-differences models to estimate changes in cancer detection rates and tumour size at diagnosis; robustness was confirmed through sensitivity and falsification tests.Results The alert disproportionately reduced detection of early-stage cancers, consistent with a collapse of preventive and opportunistic detection pathways. Women experienced larger declines in detection than men (−43.9% vs −32.0%; p=0.001) and greater increases in tumour size (17.3% vs 11.5%; p=0.026). These gaps were most pronounced among women under 50 (−50.7% vs −25.5%; p=0.001) and disadvantaged women, whose tumour size increase was nearly double that of disadvantaged men (16.6% vs 8.8%; p=0.049). The gap was particularly large for opportunistically detected cancers (lung: −47.1% women vs −22.6% men; p=0.011).Conclusions These findings reveal a system-level patient safety failure. Women’s higher engagement with routine care, ordinarily a health advantage, became a structural vulnerability when these pathways were suspended, possibly amplified by intensified caregiving, employment shocks and infection-risk avoidance. As health systems prepare for recurring shocks, resilience planning must incorporate gender-sensitive safeguards that prevent diagnostic harm. Protecting early detection pathways is both a clinical imperative and a patient safety requirement for equitable emergency response.",
  "authors": [
    {
      "affiliations": [
        "Institute of Public Health, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan",
        "School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan"
      ],
      "name": "I-Hua Chen"
    },
    {
      "affiliations": [
        "Graduate Institute of Management and Department of Health Care Management, College of Management, Chang Gung University, Taoyuan, Taiwan"
      ],
      "name": "Juifen Rachel Lu"
    },
    {
      "affiliations": [
        "Cancer Health Economics Research (CHEER) Program, UCLA Jonsson Comprehensive Cancer Center, Los Angeles, California, USA",
        "Department of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA",
        "Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA"
      ],
      "name": "Ya-Chen Tina Shih"
    },
    {
      "affiliations": [
        "Institute of Public Health, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan"
      ],
      "name": "Chang-Xi Kung"
    },
    {
      "affiliations": [
        "Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan",
        "Microbiota Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan",
        "Division of Gastroenterology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan",
        "Health Innovation Centre, National Yang Ming Chiao Tung University, Taipei, Taiwan",
        "Research Centre for Epidemic Prevention and One Health, National Yang Ming Chiao Tung University, Taipei, Taiwan"
      ],
      "name": "Chun-Ying Wu"
    },
    {
      "affiliations": [
        "Institute of Public Health, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan",
        "Health Innovation Centre, National Yang Ming Chiao Tung University, Taipei, Taiwan",
        "Research Centre for Epidemic Prevention and One Health, National Yang Ming Chiao Tung University, Taipei, Taiwan"
      ],
      "name": "Li-Lin Liang"
    }
  ],
  "title": "Paradox of engagement: precautionary public health alerts and gender inequality in cancer diagnosis—a quasi-experimental study",
  "uid": "37fa094a-7d9a-5aa7-b2ef-d8bfcad7763a"
}