Correlation of Cervical Cancer Mortality with Fertility, Access to Health Care and Socioeconomic Indicators

Vale, Diama Bhadra; Sauvaget, Catherine; Murillo, Raul; Muwonge, Richard; Zeferino, Luiz Carlos; Sankaranarayanan, Rengaswamy

doi:10.1055/s-0039-1683859

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Revista Brasileira de Ginecologia e Obstetrícia

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Original Articles, Oncology • Rev. Bras. Ginecol. Obstet. 41 (04) • Apr 2019 • https://doi.org/10.1055/s-0039-1683859 copy

Correlation of Cervical Cancer Mortality with Fertility, Access to Health Care and Socioeconomic Indicators

Correlação da mortalidade por câncer do colo do útero com fertilidade, acesso a cuidados de saúde e indicadores socioeconômicos

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

The present study aimed to examine which development indicators are correlated with cervical cancer (CC) mortality rates in Brazil.

Methods

This was an ecological study that correlatedmortality rates and indicators, such as human development index (HDI), gross domestic product (GDP) per capita, illiteracy rate, fertility rate, screening coverage, proportion of private health insurance use, density of physicians, and density of radiotherapy centers. Themortality rateswere obtained fromthe Brazilian national registry, while the indicators were based on official reports from the Ministry of Health. Univariate and multivariate linear regression was used.

Results

Among the states of Brazil, the average age-specific CC mortality rate from 2008 to 2012 varied from 4.6 to 22.9 per 100,000 women/year. In the univariate analysis, HDI, proportion of private health insurance use, density of physicians, and density of radiotherapy centers were inversely correlated with the mortality rates. Fertility rate was positively correlated with the mortality rates. In the multivariate analysis, only fertility rate was significantly associated with the CC mortality rate (coefficient of correlation: 9.38; 95% confidence interval [CI]: 5.16-13.59).

Conclusion

A decrease in the fertility rate, as expected when the level of development of the regions increases, is related to a decrease in the mortality rate of CC. The results of the present study can help to better monitor the quality assessment of CC programs both among and within countries.

Keywords:
cervical cancer; cancer mortality; fertility; human development index; health disparities

Region	State	Cervical cancer mortality^a Corrected age-specific standardized cervical cancer mortality rate, average of 2008-2012.	Human development index^b Human development index in 2000.	Gross domestic product per capita^c Gross domestic product per capita in 2000, per BRL 1,000.00.	Illiteracy rate^d Illiteracy rate in 2000, proportion of the population > 15 years old that cannot write and read.	Fertility rate^e Fertility rate in 2000, average of live births per women between 15 and 49 years old.	Screening coverage^f Screening coverage in 2003, proportion of women between 25 and 59 years old who underwent at least 1 screening test in the last 3 years.	Private health insurance^g Private health insurance in 2003, proportion of the population with access to private health insurance.	Density of Physicians^h Density of physicians in 2001, rate of physicians per 1,000 persons.	Density of radiotherapy centersⁱ Density of radiotherapy centers in 2015, medical facilities with radiotherapy per 1,000,000 persons.
North	AC	9.42	0.517	3.86	23.60	2.97	70.20	18.10	0.60	0.00
	AM	22.88	0.515	5.96	14.96	3.40	68.16	13.50	0.60	10.16
	AP	15.02	0.577	4.94	11.57	3.61	72.85	16.20	0.42	0.00
	PA	13.41	0.518	3.08	15.92	3.15	71.73	16.70	0.51	4.89
	RO	8.29	0.537	4.31	12.16	2.73	85.06	9.60	0.59	11.31
	RR	12.69	0.598	5.48	12.33	3.66	71.25	18.60	0.10	0.00
	TO	10.86	0.525	3.17	17.82	2.92	69.97	7.10	0.72	6.60
Northeast	AL	9.22	0.471	2.75	31.73	3.16	47.68	8.40	0.95	8.98
	BA	6.60	0.512	3.56	21.99	2.50	69.09	13.30	0.86	5.26
	CE	7.77	0.541	3.04	24.95	2.81	69.27	11.80	0.75	4.49
	MA	13.46	0.476	2.11	27.09	3.22	60.33	6.80	0.45	2.90
	PB	6.64	0.506	2.71	28.19	2.53	60.94	12.50	0.94	5.03
	PE	8.03	0.544	3.40	22.97	2.49	72.91	15.70	1.09	5.35
	PI	9.86	0.484	2.13	29.16	2.65	75.40	10.80	0.60	6.24
	RN	6.66	0.552	3.28	23.85	2.54	72.92	10.80	0.90	2.91
	SE	10.44	0.518	3.66	23.72	2.75	64.85	13.60	0.85	8.92
Midwest	DF	6.45	0.725	22.66	5.35	2.19	75.42	32.20	2.73	13.72
	GO	7.49	0.615	5.25	11.21	2.24	77.68	23.40	1.10	6.05
	MT	8.18	0.601	5.94	11.32	2.46	67.73	17.20	0.69	6.12
	MS	8.83	0.613	5.45	10.60	2.10	81.97	29.70	1.03	11.32
Southeast	ES	7.31	0.640	7.51	10.82	2.05	78.79	24.70	1.39	7.63
	MG	5.13	0.624	5.62	11.32	2.22	70.54	25.40	1.40	11.98
	RJ	7.21	0.664	9.71	6.13	2.07	76.02	30.10	2.96	13.90
	SP	4.62	0.702	11.45	6.14	2.07	81.22	38.20	1.97	15.54
South	PR	6.50	0.650	7.23	8.93	2.09	73.91	24.10	1.24	13.44
	RS	5.91	0.664	8.03	6.21	2.11	75.65	31.90	1.82	16.89
	SC	5.93	0.674	8.09	5.83	2.04	80.38	27.20	1.13	14.66

	Univariate analysis			Multivariate analysys
Indicator	Coefficient	95% CI	p-value	Coefficient	95% CI	p-value
Human development index^b Human development index in 2000.	−0.03	−0.04; −0.01	0.01	−0.01	−0.05; + 0.02	0.50
Gross domestic product per capita^c Gross domestic product per capita in 2000, per BRL 1,000.00.	−0.26	−0.62; +0.11	0.17
Illiteracy rate^d Illiteracy rate in 2000, proportion of the population > 15 years old that cannot write and read.	+0.09	−0.10; +0.28	0.34
Fertility rate^e Fertility rate in 2000, average of live births per women between 15 and 49 years old.	+ 6.08	+ 4.16;+ 8.00	< 0.001	+ 7.54	+ 4.48; + 10.59	< 0.001
Screening coverage^f Screening coverage in 2003, proportion of women between 25 and 59 years old who underwent at least 1 screening test in the last 3 years.	−0.14	−0.34;+ 0.06	0.17
Private health insurance^g Private health insurance in 2003, proportion of the population with access to private health insurance.	−0.20	−0.36;−0.04	0.02	+0.12	−0.17; + 0.41	0.85
Physician density^h Density of physicians in 2001, rate of physicians per 1,000 persons.	−3.06	−5.09;−1.03	0.01	−0.59	−3.14; + 1.95	0.63
Density of radiotherapy centresⁱ Density of radiotherapy centers in 2015, medical facilities with radiotherapy per 1,000,000 persons.	−0.31	−0.60;−0.01	0.04	+ 0.25	−0.06; + 0.58	0.11

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[1] Address for correspondence
Diama Bhadra Vale, Departamento de Tocoginecologia, Universidade Estadual de Campinas, Cidade Universitária Zeferino Vaz, 13083-970, Barão Geraldo, Campinas, SP, Brazil (e-mail: dvale@unicamp.br; diamavale@gmail.com).