{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T16:06:10Z","timestamp":1779465970500,"version":"3.53.1"},"reference-count":52,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Pandemic-related disruptions in cirrhosis care resulted in major gaps and delays in surveillance for hepatocellular carcinoma (HCC). Whether these initial declines improved and rebounded to prepandemic levels remains unclear.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate contemporary clinical practice data on HCC surveillance utilization from before the COVID-19 pandemic to 4 years after the onset of the pandemic among safety-net populations with cirrhosis.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This retrospective cohort study was conducted at 5 safety-net health systems in the US. Adults with cirrhosis were evaluated longitudinally across 3 time periods: March 1, 2018, to February 29, 2020 (pre\u2013COVID-19 period), March 1, 2020, to February 28, 2022 (COVID-19 era), and March 1, 2022, to February 29, 2024 (post\u2013COVID-19 period).<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n \n The primary outcome was undergoing HCC surveillance identified using\n Current Procedural Terminology<\/jats:italic>\n codes for ultrasonography, computed tomography, and magnetic resonance imaging, and corresponding\n International Statistical Classification of Diseases, Tenth Revision, Clinical Modification<\/jats:italic>\n diagnosis codes for indication. Comparisons of HCC surveillance across time periods used paired\n t<\/jats:italic>\n tests, and comparisons of HCC surveillance between subgroups within the same time period used \u03c7\n 2<\/jats:sup>\n tests.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Among 6940 patients with cirrhosis, 4001 (57.7%) were men (median [IQR] age, 58 [52-64] years), 206 (3.0%) were Asian, 1720 (24.8%) were Hispanic, 1672 (24.1%) were non-Hispanic Black or African American, and 3081 (44.4%) were non-Hispanic White. The proportion who underwent HCC surveillance within 6 months after diagnosis was 30.8% (1940 patients) in the pre\u2013COVID-19 era, which declined to 21.1% (1468 patients) in the COVID-19 era, and remained at 22.3% (1405 patients) in the post\u2013COVID-19 era. Consistent trends were observed among men and women and among all age and race groups, except for Asian individuals, for whom there was an observed increase in the post\u2013COVID-19 era. Similar trends of low HCC surveillance post\u2013COVID-19 were observed across insurance types but was particularly concerning among uninsured or indigent care covered patients, among whom only 116 of 997 (11.9%) underwent surveillance in the most recent period.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this observational study of US safety-net populations with cirrhosis, rates of HCC surveillance following pandemic-related declines remained persistently low even up to 4 years after the onset of the COVID-19 pandemic, with fewer than 1 in 4 patients having undergone guideline-concordant HCC surveillance.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.14345","type":"journal-article","created":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T15:30:29Z","timestamp":1779463829000},"page":"e2614345","source":"Crossref","is-referenced-by-count":0,"title":["Pandemic-Related Disruptions and Hepatocellular Carcinoma Surveillance in Safety-Net 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Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronnie","family":"Fass","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, MetroHealth Hospital and Health System, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Prieto-Bello","sequence":"additional","affiliation":[{"name":"Division of Digestive Health and Liver Diseases, University of Miami School of Medicine and Jackson Memorial Health System, Miami, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Quirk","sequence":"additional","affiliation":[{"name":"Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center and Parkland Health, Dallas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Therapondos","sequence":"additional","affiliation":[{"name":"Multiorgan Transplant Institute, Ochsner Health, New Orleans, 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