Juliano dos Santos

Ovarian cancer mortality in the states of Northeast and South Brazil (1980-2019): effect of age-period and cohort

Abstract The scope of this study was to conduct an analysis on the effect of the Age-Period-Cohort (APC) on ovarian cancer mortality in the South and Northeast regions of Brazil. The APC models were estimated by Poisson regression through estimable functions in women aged 30 and over residing in the states of the South and Northeast regions. Upon estimating the APC models, a positive gradient was found in mortality rates with advancing age in all locations The South region showed a reduction in the risk of death in the last two periods (RR2010-2014 0.94; RR2015-2019 0.90, p<0.001) and a reduction in risk in the cohorts from 1900 to 1929 (RR1900-04 0.55, RR1925-1929 0.89, p<0.001); a similar profile was observed in all states. In the Northeast, there was a progressive increase in the risk of death in the last periods, ranging from 1.02 to 1.11 (2010-2014 vs. 2015-2019, p<0.001). An increased risk of death was observed in younger cohorts, varying from 0.31 to 1.54 (cohort 1900-1904 vs. 1985-1989). Similar results were observed in most of the states.: The conclusion drawn is that heterogeneity in the APC effect on ovarian cancer mortality, which may be correlated with the different rates of the population aging process, changes in the reproductive behavior of women, and inequalities in access to health services.

Inequalities in Temporal Effects on Cervical Cancer Mortality in States in Different Geographic Regions of Brazil: An Ecological Study

Cervical cancer is a public health issue with high disease burden and mortality in Brazil. The objectives of the present study were, firstly, to analyze age, period, and cohort effects on cervical cancer mortality in women 20 years old or older from 1980 to 2019 in the North, South, and Southeast Regions of Brazil; and secondly, to evaluate whether the implementation of a national screening program and the expansion of access to public health services impacted the examined period and reduced the risk of death compared with previous years and among younger cohorts. The effects were estimated by applying Poisson regression models with estimable functions. The highest mortality rate per 100,000 women was found in Amazonas (24.13), and the lowest in São Paulo (10.56). A positive gradient was obtained for death rates as women’s age increased. The states in the most developed regions (South and Southeast) showed a reduction in the risk of death in the period that followed the implementation of the screening program and in the cohort from the 1960s onwards. The North Region showed a decreased risk of death only in Amapá (2000–2004) and Tocantins (1995–2004; 2010–2019). The findings indicate that health inequities remain in Brazil and suggest that the health system has limitations in terms of decreasing mortality associated with this type of cancer in regions of lower socioeconomic development.