Spatial-temporal analysis of cervical cancer screening and social and health indicators in Brazil.
To identify the spatial-temporal patterns of cervical cancer (CC) screening in Brazil from 2013 to 2022 and its relationship with social and health indicators. This ecological study uses data from the Cancer Information System (SISCAN) of the Brazilian Unified Health System's Department of Informatics. The study analyzed women aged 25 to 64 who underwent CC screening in 5570 municipalities across Brazil. Global Moran's I and the Local Index of Spatial Autocorrelation (LISA) were employed to investigate clustering. The purely spatial scan statistic technique was used for spatial cluster detection. Temporal trends were assessed using joinpoint regression. GeoDa, SaTScan, GWR, and QGIS software were used for the analysis. The global clustering analysis of CC screening proportions revealed significant spatial autocorrelation (Moran's I = 0.530). Clusters of municipalities with low screening rates were significantly observed in the Northern (Amapá, Amazonas, Rondônia, Roraima) and Northeastern (Piauí, Pernambuco) regions. The Gini Index (β = -2.60), the Municipal Human Development Index (MHDI) (β = -10.5), and the Social Vulnerability Index (SVI) (β = -9.14) showed negative associations. Conversely, Family Health Strategy (FHS) coverage (β = 2.18) demonstrated a positive impact on screening rates. In terms of temporal trends, the screening proportion gradually increased from 5.4 % in 2014 to 10.5 % in 2022. Areas with a high risk of low CC screening rates were identified in the Northern and Northeastern regions of Brazil, which are characterized by socioeconomic and demographic disparities, vulnerabilities, and inequalities.
