Health Iniquity, Unhealthy Behavior, and Coverage of Mammography in Brazil

To investigate the prevalence of mammography screening and the association among socio-demographic, behavior factors and non-adherence to mammography screening among women between 50 and 69 years old, using data from Vigitel 2016.

Method:

Cross-sectional, population-based study with data from Vigitel including 12,740 women in the 50-69 age group. The variables were analyzed using logistic regression.

Results:

Among the women studied, 21.8% had not had a mammography in the past 2 years. The characteristics associated with non-adherence to the test were having less than 12 years of education (p<0.001), having no partner (p=0.001), being underweight (p=0.002), having a negative self-perceived health status (p<0.001) and having at least one negative health behavior (p<0.001).

Conclusion:

There is a subgroup of women with markers of social vulnerability, which reflect the inequality in mammography screening.

Descriptors:
Mammography; Health Status Disparities; Health Services Coverage; Health Services Accessibility; Mass Screening

Socio-demographic characteristics	n^* * sample size,	%^† † population estimate, (±SE^‡ ‡ standard error )	Non-adherence to mammography screening
Socio-demographic characteristics	n^* * sample size,	%^† † population estimate, (±SE^‡ ‡ standard error )	%^† † population estimate, (95% CI^§ § 95% confidence interval, )	OR^\|\| \|\| Odds Ratio. (95% CI^§ § 95% confidence interval, )
Skin color/race	11.520
White	5.936	52.3 (1.0)	19.5 (17.18-22.08)	Ref.
Brown and black	5.240	44.3 (1.0)	22.9 (20.28-25.76)	1.22 (0.98-1.52)
Yellow and indigenous	344	3.4 (0.4)	25.8 (16.82-37.53)	1.43 (0.81-2.53)
Age group (years)	12.740
50 to 59	6.359	62.1 (0.9)	22.0 (19.73-24.51)	1.00 (0.85-1.24)
60 to 69	6.381	37.9 (0.9)	21.5 (19.38-23.71)	Ref.
Level of education (years)	12.740
12 or more	4.280	19.6 (0.6)	9.5 (7.85-11.37)	Ref.
9 to 11	4.249	28.6 (0.8)	17.6 (15.44-19.95)	2.04 (1.57-2.64)
0 to 8	4.211	51.8 (0.9)	28.8 (26.04-31.76)	3.87 (3.02-4.96)
Marital status	12.573
With a partner	6.427	58.0 (0.9)	18.7 (16.49-21.13)	Ref.
Without a partner	6.146	42.0 (0.9)	26.3 (23.85-28.93)	1.55 (1.26-1.89)
Region	12.740
South	1.607	9.1 (0.3)	18.8 (16.17-21.74)	Ref.
Center-West	1.996	10.4 (0.4)	20.8 (16.97-25.29)	1.13 (0.83-1.55)
Southeast	2.038	49.1 (0.9)	22.2 (19.22-25.48)	1.23 (0.95-1.59)
North	2.721	7.8 (0.2)	22.5 (19.77-25.50)	1.25 (0.98-1.60)
Northeast	4.378	23.7 (0.6)	22.4 (20.48-24.44)	1.24 (1.00-1.54)

Behavior and health variables	n^* * sample size,	%^† † population estimate, (±SE^‡ ‡ standard error, )	Non-adherence to mammography screening
Behavior and health variables	n^* * sample size,	%^† † population estimate, (±SE^‡ ‡ standard error, )	%^† † population estimate, (95% CI^§ § Odds Ratio, )	OR^§ § Odds Ratio, (95% CI^\|\| \|\| 95% confidence interval, ¶ body mass index, )
Diabetes	12.740
No	10.573	82.4 (0.7)	20.9 (19.12-22.79)	Ref.
Yes	2.167	17.6 (0.7)	26.1 (21.99-30.68)	1.33 (1.03-1.71)
Hipertension	12.740
No	6.675	51.5 (0.9)	19.7 (17.58-22.07)	Ref.
Yes	6.065	48.5 (0.9)	24.0 (21.58-26.68)	1.28 (1.05-1.57)
Nutritional status	12.740
Adequate weight	4.844	37.6 (0.9)	21.4 (18.66-24.43)	Ref.
Underweight	249	2.00 (0.2)	42.6 (29.56-56.68)	2.72 (1.50-4.92)
Overweight	4.805	36.1 (0.9)	19.1 (16.76-21.60)	0.86 (0.68-1.09)
Obesity	2.842	24.3 (0.8)	24.8 (21.3-28.76)	1.21 (0.93-1.57)
Physical activity during leisure time^ "150 minutes of light or moderate physical activity per week or at least 75 minutes of vigorous physical activity per week"(19),	12.740
Active	4.134	26.1 (0.8)	11.3 (9.32-13.7)	Ref.
Inactive	8.606	73.9 (0.8)	25.5 (23.44-27.7)	2.68 (2.09-3.42)
Recommended intake of fruits and vegetables^†† †† "five or more times a day, five or more days a week"(19).	12.740
Yes	4.486	33.3 (0.9)	15.1 (12.69-18.03)	Ref.
No	8.254	66.7 (0.9)	25.1 (23.04-27.35)	1.87 (1.48-2.37)
Smoking	12.740
No	7.799	58.3 (1.0)	19.3 (17.45-21.39)	Ref.
Ex-smoker	3.832	29.8 (0.9)	21.9 (18.88-25.25)	1.16 (0.93-1.46)
Yes	1.109	11.8 (0.7)	33.8 (27.72-40.44)	2.12 (1.55-2.90)
Alcohol intake	12.739
No	9.553	75.4 (0.8)	22.5 (20.65-24.56)	Ref.
Yes	3.186	24.6 (0.8)	19.5 (16.35-23.20)	0.83 (0.65-1.06)
Self-perceived health status	12.688
Positive (very good, good)	7.605	59.8 (0.5)	16.9 (15.09-18.98)	Ref.
Negative (regular, poor, very poor)	5.083	40.2 (0.5)	28.2 (25.38-31.22)	1.92 (1.57-2.35)
Health insurance	12.689
Yes	7.353	57.7 (0.5)	11.2 (9.60-12.97)	Ref.
No	5.336	42.3 (0.5)	30.8 (28.11-33.51)	3.53 (2.85-4.36)
Unhealthy behaviors	12.739
None	907	5.5 (0.4)	5.5 (3.71-7.92)	Ref.
One	3.047	21.7 (0.8)	16.1 (13.14-19.57)	3.33 (2.08-5.30)
Two	5.157	39.8 (0.9)	22.5 (20.04-25.12)	5.03 (3.28-7.71)
Three	2.888	26.3 (0.9)	25.4 (21.90-29.33)	5.92 (3.78-9.25)
Four	740	6.7 (0.5)	35.6 (27.95-44.08)	9.59 (5.61-16.40)

Socio-demographic, behavior, and health variables	Adjusted OR^* * Odds Ratio, (95% CI^† † 95% confidence interval. )	p
Level of education (years)
12 or more	Ref.
9 to 11	1.88 (1.43-2.47)	<0.001
0 to 8	3.24 (2.48-4.22)	<0.001
Marital status
With partner	Ref.
Without partner	1.43 (1.16-1.76)	0.001
Nutritional status
Adequate weight	Ref.
Underweight	2.38 (1.36-4.15)	0.002
Overweight	0.79 (0.62-1.01)	0.070
Obesity	1.04 (0.79-1.37)	0.769
Self-perceived health status
Positive (very good, good)	Ref.
Negative (regular, poor, very poor)	1.51 (1.22-1.87)	<0.001
Unhealthy behaviors
None	Ref.
One	2.79 (1.69-4.60)	<0.001
Two	3.86 (2.43-6.14)	<0.001
Three	4.29 (2.65-6.94)	<0.001
Four	7.55 (4.25-13.39)	<0.001

Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
E-mail: reben@abennacional.org.br

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[1] Corresponding author: Gustavo Velasquez-Melendez. E-mail: guveme@ufmg.br