COVID-19 e exames de Papanicolau: estudo com Índice de Desenvolvimento Humano Municipal em São Paulo entre 2019-2023

Abstract

Objective: to analyze the impact of the COVID-19 pandemic on Pap smear performance and the detection of cervical lesions in municipalities of São Paulo, considering socioeconomic disparities measured by the Municipal Human Development Index (MHDI). Methodology: a retrospective study based on secondary data from 2019 to 2023, evaluating the total number of tests performed and the diagnoses of CIN1, CIN2/3, adenocarcinoma, and carcinoma. Analyses were carried out using RStudio software, applying the Shapiro-Wilk normality test and robust regression to explore the relationship between MHDI and test rates. Results: during the study period, 3,055,179 tests were performed, with a sharp 38.36% decline in 2020, followed by progressive recovery until surpassing pre-pandemic levels in 2023. High-grade lesions (CIN2/3) increased from 1,730 cases in 2019 to 2,491 in 2023, while CIN1 showed only minor variation and a modest decline in the final year. In total, 244 cases of adenocarcinoma and 257 of carcinoma were identified. Regressions did not show statistical significance for the association between MHDI and test rates. Conclusion: the pandemic had a strong impact on screening, but subsequent recovery suggests resilience of the healthcare system. The MHDI proved insufficient to explain local variations, reinforcing the importance of updated indicators and public policies that guarantee the continuity of preventive care in times of crisis.

Keywords: Cervical Cancer. Pap Smear. COVID-19. Human Development Index. Epidemiology.