Association of cervical and breast cancer mortality with socioeconomic indicators and availability of health services

Cancer Epidemiol. 2020 Feb:64:101660. doi: 10.1016/j.canep.2019.101660. Epub 2019 Dec 23.

Abstract

Objective: Analyze cervical and breast cancer mortality in Brazil and its relationship with socioeconomic population indicators and availability of health services in the period 2011-2015.

Methods: An ecological study is presented herein. Mortality data were extracted from the Mortality Information System, based on ICD-10, per area of residence and age group, for the period 2011-2015. Socioeconomic variables were extracted from the Brazilian Human Development Atlas, and the National Register of Health Facilities (CNES) provided data on the density of physicians and health services. Statistical analysis was carried out using the Chi-squared test and Poisson regression, with robust variance and 95 % confidence level.

Results: The median age-standardized mortality rates for cervical and breast cancers were, respectively, 5.95 (± 3.97) and 10.65 (± 3.12) per 100,000 women. High cervical cancer mortality rates presented a statistically significant association with GINI Index (p=0.000) and Human Development Index - HDI (p=0.030). High breast cancer mortality rates were positively associated with the variables "number of general physicians per 100,000 inhabitants" (p = 0.005) and "Number of licensed oncology centers per 1,000,000 inhabitants" (p = 0.002).

Conclusion: The importance of organization and equity in the access to health services is highlighted herein, enabling the reorientation of public policies aimed at the minimization of health disparities.

Keywords: Breast cancer; Cervical cancer; Epidemiology; Health disparities; Oncology; Social determinants of health.

MeSH terms

  • Brazil / epidemiology
  • Breast Neoplasms / economics
  • Breast Neoplasms / mortality*
  • Evaluation Studies as Topic
  • Female
  • Health Services / statistics & numerical data
  • Health Services Accessibility / statistics & numerical data*
  • Humans
  • Income / statistics & numerical data
  • Socioeconomic Factors
  • Uterine Cervical Neoplasms / economics
  • Uterine Cervical Neoplasms / mortality*