Banca de DEFESA: KÁLYA YASMINE NUNES DE LIMA
Uma banca de DEFESA de DOUTORADO foi cadastrada pelo programa.STUDENT : KÁLYA YASMINE NUNES DE LIMA
DATE: 28/01/2021
TIME: 08:00
LOCAL: Departamento de Saúde Coletiva
TITLE:
Inequalities in lung cancer mortality and staging in Brazil
KEY WORDS:
PAGES: 100
BIG AREA: Ciências da Saúde
AREA: Saúde Coletiva
SUBÁREA: Epidemiologia
SUMMARY:
The objective was to analyze the stage of diagnosis and mortality from lung cancer and its relationship with socioeconomic factors and the provision of health services in Brazil. This is an ecological and cross-sectional study. Deaths (C33-34) were collected from the Mortality Information System for the period from 2011 to 2015. Individual data related to cancer diagnosis and socioeconomic conditions were obtained from the Integrator of Hospital Cancer Records for the period 2006 to 2015. The contextual variables were collected in the Atlas of Human Development in Brazil, in the National Register of Health Facilities and in the National Supplementary Health Agency. For analysis of mortality and late diagnosis of lung cancer, the Chi-Square test and the Poisson Regression with robust variance were applied to a 95% confidence level. The spatial dependence on mortality rates and the proportion of delayed diagnosis (PDD) were verified by the Moran Global index and the Local Spatial Association Indicator. Early diagnosis was analyzed using Pearson's chi-square test and multilevel Poisson regression. The average age-adjusted mortality rate between 2011 and 2015 was 12.8 deaths per 100,000 inhabitants. The high mortality rates from lung cancer were significantly associated with the density of general practitioners (PR = 1.68), establishments qualified in oncology (PR = 1.49) and inversely associated with % of poor (PR = 1.73) and, they presented spatial autocorrelation (Moran = 0.5; p = 0.01). The multivariate spatial model was constituted by the variables Establishments qualified in oncology, Income and Coverage of health plans and presented an explanatory power of 66% for lung cancer mortality. Between 2011 and 2015, the PDD was 85.49% for the population between 18 and 99 years old. PDD, combined for both sexes, showed low spatial autocorrelation, however significant (Moran = 0.37; p = 0.01) and correlation with Aging Rate (0.109; p = 0.010),% of Workers Exposed to carcinogenic agents (p = 0.019), Gini (p = 0.001) and Density of Primary Health Care Teams (p = 0.042). From 2006 to 2015, 87.71% of cases were diagnosed at an advanced stage. The age group of 50 to 59 years (PR = 1.04), male (PR = 1.02), non-white race / color (PR = 1.01), incomplete elementary education (PR = 1.05) and small cell tumors (PR = 1.08) are associated with advanced diagnosis. For the same period, the proportion of early lung cancer diagnosis was associated with an older age group (70 years or older - RP 1.30; CI 1.14-1.48), with higher education (RP 1.45 ; CI 1.24-1.69), female (PR 1.18; CI 1.10-1.26) and squamous cell tumor (PR 1.19; CI 1.10-1.29). Early diagnosis was not associated with contextual variables. There are inequalities in the distribution of lung cancer mortality rates related to the provision of health services and socioeconomic conditions. The absence of a direct relationship between the context and the stage of cancer in the diagnosis points to the greater influence that the individual and tumor characteristics have on the detection of cancer.
BANKING MEMBERS:
Externo à Instituição - ARN MIGOWSKI ROCHA DOS SANTOS - INCA
Interna - 2149611 - CLELIA DE OLIVEIRA LYRA
Externa à Instituição - CRISTIANE MURTA RAMALHO NASCIMENTO - UNESP
Presidente - 3926907 - DYEGO LEANDRO BEZERRA DE SOUZA
Interna - 2305247 - ISABELLE RIBEIRO BARBOSA MIRABAL