Karina Cardoso Meira

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.

Desigualdades sociais no diagnóstico do câncer do colo do útero no Brasil: um estudo de base hospitalar

Resumo O estudo visa analisar a prevalência de estadiamento avançado ao diagnóstico do câncer do colo do útero e sua associação com indicadores individuais e contextuais socioeconômicos e de oferta de serviços de saúde no Brasil. Estudo transversal, realizado com casos de câncer do colo do útero em mulheres de 18 a 99 anos, no período de 2006 a 2015, extraídos do Integrador de Registros Hospitalares de Câncer. Variáveis contextuais foram coletadas no Atlas do Desenvolvimento Humano, no Cadastro Nacional de Estabelecimentos de Saúde e no Sistema de Informações Ambulatoriais. Usou-se o modelo de regressão de Poisson multinível com intercepto aleatório. A prevalência de diagnóstico em estádio avançado foi de 48,4%, apresentando associação com idades mais avançadas (RP 1,06; IC 1,01-1,10), raça/cor da pele preta, parda e indígena (RP 1,04; IC 1,01-1,07), menores níveis de escolaridade (RP 1,28; IC 1,16-1,40), ausência de parceiro conjugal (RP 1,10; IC 1,07-1,13), encaminhamento do tipo público ao serviço de saúde (RP 1,07; IC 1,03-1,11) e menor taxa de realização de exame citopatológico (RP 1,08; IC 1,01-1,14). Os resultados reforçam a necessidade de melhorias no programa nacional de prevenção do câncer do colo do útero em áreas com baixa cobertura da citologia oncótica.

Analysis of the effects of the age-period-birth cohort on cervical cancer mortality in the Brazilian Northeast

Cervical cancer (CC) is a public health problem with a high disease burden and mortality in developing countries. In Brazil, areas with low human development index have the highest incidence rates of Brazil and upward temporal trend for this disease. The Northeast region has the second highest incidence of cervical cancer (20.47 new cases / 100,000 women). In this region, the mortality rates are similar to rates in countries that do not have a health system with a universal access screening program, as in Brazil. Thus, this study aimed to analyze the effects of age, period and birth cohorts on mortality from cervical cancer in the Northeast region of Brazil. Estimable functions predicted the effects of age, period and birth cohort. The average mortality rate was 10.35 deaths per 100,000 women during the period analyzed (1980-2014). The highest mortality rate per 100,000 women was observed in Maranhão (24.39 deaths), and the lowest mortality rate was observed in Bahia (11.24 deaths). According to the period effects, only the state of Rio Grande do Norte showed a reduction in mortality risk in the five years of the 2000s. There was a reduction in mortality risk for birth cohorts of women after the 1950s, except in Maranhão State, which showed an increasing trend in mortality risk for younger generations. We found that the high rates of cervical cancer mortality in the states of northeastern Brazil remain constant over time. Even after an increase in access to health services in the 2000s, associated with increased access to the cancer care network, which includes early detection (Pap Test), cervical cancer treatment and palliative care. However, it is important to note that the decreased risk of death and the mortality rates from CC among women born after the 1960s may be correlated with increased screening coverage, as well as increased access to health services for cancer treatment observed in younger women.

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.