Banca de QUALIFICAÇÃO: NAYARA PRISCILA DANTAS DE OLIVEIRA

Uma banca de QUALIFICAÇÃO de DOUTORADO foi cadastrada pelo programa.
STUDENT : NAYARA PRISCILA DANTAS DE OLIVEIRA
DATE: 19/06/2020
TIME: 09:00
LOCAL: Ambiente Virtual
TITLE:

Inequalities in illness and death from breast and cervical cancer in Brazil

KEY WORDS:

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

PAGES: 130
BIG AREA: Ciências da Saúde
AREA: Saúde Coletiva
SUBÁREA: Epidemiologia
SUMMARY:

Breast and cervical cancers stand out among the most incident and lethal types of female cancer, with considerable regional differences that point to the health disparities that permeate the associated morbidity and mortality. The discussion on inequalities in illness and death due to breast and cervical cancer enables the understanding of the impact of such diseases at the population level. The objective of this study was to analyze the staging and mortality from breast and cervical cancer and its connection with socioeconomic factors and the distribution of health services in Brazil. This is an observational, ecological and cross-sectional study. The mortality data (CIDO-3 C50 and C53) were collected from the Mortality Information System (SIM) for the period from 2011 to 2015. Individual data related to the diagnosis of cancer and socioeconomic conditions of women were obtained from the Integrator of Hospital Cancer Registries (RHC) for the period from 2006 to 2015. The contextual socioeconomic variables were collected in the Atlas of Human Development in Brazil and the data on density of doctors and health services from the National Registry of Health Facilities (CNES). The descriptive analysis of the data was performed by georeferencing for the creation of thematic maps. The mortality analysis was performed using the Chi-squared test and Poisson regression with robust variance for a 95% confidence level. For the analysis of late staging at the oncological diagnosis, the Chi-squared test and the Multilevel Poisson Regression model were chosen, with a random intercept. To verify the existence of territorial clusters, the Moran Global index and the Local Indicator of Spatial Association (LISA) were used. In multivariate spatial analysis, models with global spatial effects were used. 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. It is observed that the high mortality rate due to cervical cancer was statistically significantly associated with the GINI Index (p = 0.000) and Human Development Index (HDI) (p = 0.030). The high mortality rates from breast cancer were associated with the density of general practitioners (p = 0.005) and the density of health facilities qualified in oncology (p = 0.002). The proportion of late breast cancer diagnosis in Brazil was of 40.0%, varying among states and regions of the country. The results of the multilevel analysis indicate that the late diagnosis of breast cancer is associated with younger age groups (p <0.001), with the non-white race/color of the skin (p <0.001), with lower levels of education (p <0.001) and public access to health services (p <0.001). There is also an association between the late diagnosis of breast cancer and the low density of mammography devices in use (p <0.001). There is a positive association of late diagnosis with higher rates of local social inequality (p = 0.002), and a negative one with lower HDI values (p = 0.010). In the results obtained from the spatial analysis, it is observed that the adjusted breast cancer mortality rates showed a statistically significant spatial correlation with the HDI (p <0.001) and with the density of gynecologists (p <0.001). The proportion of late breast cancer diagnosis showed a spatial correlation with the GINI Index (p = 0.001) and with the density of gynecologists (p = 0.009). The study highlights the social inequalities involved in late diagnosis and mortality from breast and cervical cancer in Brazil. The importance of structuring equality in the access to health services and technologies in the Brazilian territory is highlighted. In addition, the reorientation of public health policies would make it possible to optimize the control, prevention and timely treatment of breast and cervical cancer.

BANKING MEMBERS:
Interno - 1149540 - ANGELO GIUSEPPE RONCALLI DA COSTA OLIVEIRA
Interna - 2149611 - CLELIA DE OLIVEIRA LYRA
Presidente - 3926907 - DYEGO LEANDRO BEZERRA DE SOUZA