Banca de DEFESA: NAYARA PRISCILA DANTAS DE OLIVEIRA

Uma banca de DEFESA de DOUTORADO foi cadastrada pelo programa.
STUDENT : NAYARA PRISCILA DANTAS DE OLIVEIRA
DATE: 25/09/2020
TIME: 09:00
LOCAL: Ambiente Virtual
TITLE:
KEY WORDS:

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

PAGES: 200
BIG AREA: Ciências da Saúde
AREA: Saúde Coletiva
SUBÁREA: Epidemiologia
SUMMARY:

Breast and cervical cancers stand out among female cancer types with high incidence and mortality rates, which have considerable regional differences. The discussion on inequalities in the diagnosis and death due to breast and cervical cancer enables the understanding of the understanding of these diseases at the individual and population levels. The objective of this thesis was to analyze the staging and mortality from breast and cervical cancer and its connection with socioeconomic context and the distribution of health services in Brazil. Five observational studies were developed, one of the classic ecological type, two cross-sectional studies and two of the ecological type of spatial analysis. The mortality data were collected from the Mortality Information System (SIM). Individual data related to the diagnosis of cancer were obtained from the Integrator of Hospital Cancer Registries (RHC). The contextual socioeconomic variables were collected in the Atlas of Human Development in Brazil and the data on offer of health services from the National Registry of Health Institutions (NRHI), the Outpatient Health Information System (SIA-SUS) and the Agency National Supplementary Health (ANS). The mortality analysis was performed using the Poisson regression with robust variance. For the analysis of advanced staging, the Multilevel Poisson Regression model was chosen, with a random intercept. In the spatial analysis, the Moran Global Index and the Local Spatial Association Indicator (LISA) and the models with global spatial effects were used. The main results were: (1) The average age-standardized mortality rates for cervical and breast cancers were, respectively, 5.95 (±3.97) and 10.65 (±3.12) per 100,000 women. The high mortality rate from breast cancer was associated with a higher density of general practitioners and a greater offer of health services in oncology. The high mortality rate due to cervical cancer was associated with higher rates of local social inequality and lower levels of human development in the regions evaluated. (2) The proportion of late breast cancer diagnosis in Brazil was of 40.0%. Advanced staging was associated with individual and contextual factors related to public access to health services and the low density of mammography equipment. (3) In 32.4% of cervical cancer cases, staging was absent, significantly associated with individual and contextual factors in the provision of health services. The proportion of advanced staging was 48.4%, with association with individual and contextual factors of public access to health services and the low proportion of cytopathological exams. (4) Advanced staging of breast cancer presented positive spatial correlation with the Gini Index and a negative one with the density of gynecologists. Mortality rates presented a positive spatial correlation with the HDI and the density of gynecologists. (5) Advanced staging of cervical cancer presented a positive spatial correlation with the Gini Index and a negative correlation with the proportion of beneficiaries of private health plans. Mortality rates presented a positive spatial correlation with the Gini Index and a negative one with the density of gynecologists. The study highlights the social inequalities involved in advanced staging 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:
Presidente - 3926907 - DYEGO LEANDRO BEZERRA DE SOUZA
Interna - 2149611 - CLELIA DE OLIVEIRA LYRA
Externa ao Programa - 1674688 - TATYANA MARIA SILVA DE SOUZA ROSENDO
Externo à Instituição - ARN MIGOWSKI ROCHA DOS SANTOS - INCA
Externo à Instituição - GUSTAVO PINA GODOY - UFPE