Trends and associations of pulmonary nodule detection rates in China, 2019–2023: A multicenter cross-sectional study based on Real-World Data

Abstract

The post-coronavirus disease 2019 (COVID-19) pulmonary sequelae have garnered public concern. We conducted a multicenter cross-sectional study in outpatient and health exam populations from 23 clinical centers (including university-affiliated/provincial general hospitals, municipal general hospitals, county hospitals, and specialized hospitals) in China (2019−2023), to assess temporal trends and potential influencing factors in the detection of CT-diagnosed pulmonary nodules, pleural effusion, pneumonia, and suspected lung tumors, cancer and viral pneumonia, clarifying pandemic impacts on lung health. Dynamic comparisons across key phases including initial outbreak, vaccine rollout, population-wide vaccination, and major adjustment of pandemic control policies, were performed. This study analyzed 1,616,750 clinical samples (1,102,605 outpatient, 514,145 health examination; 885,945 males, 730,805 females). Pulmonary nodule detection rose progressively, with surges in 2020−2021 and 2023, plateauing in 2021−2022. Outpatients and males showed steeper increases. University-affiliated/provincial hospitals had sharpest increases vs. municipal and county tiers. Specialized hospitals matched general hospital rates. AI boosted detection rates. CT-suspected lung tumors/cancer remained low and stable, unrelated to nodule trends. These results underscore 2019−2023 pulmonary nodule detection surges linked to SARS-CoV-2 infections and AI adoption. COVID-19 vaccination did not accelerate detection but may have slowed it short-term. Long-term studies on infection, vaccine impacts and pandemic-detected nodules’ outcomes are urgently needed.