Disparities in cervical and breast cancer mortality in
					Brazil

Girianelli, Vania Reis; Gamarra, Carmen Justina; Azevedo e Silva, Gulnar

doi:10.1590/S0034-8910.2014048005214

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Brasil

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Sumário

Original Articles • Rev. Saúde Pública 48 (3) • June 2014 • https://doi.org/10.1590/S0034-8910.2014048005214 copy

Disparities in cervical and breast cancer mortality in Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE

To analyze cervical and breast cancer mortality in Brazil according to socioeconomic and welfare indicators.

METHODS

Data on breast and cervical cancer mortality covering a 30-year period (1980-2010) were analyzed. The data were obtained from the National Mortality Database, population data from the Brazilian Institute of Geography and Statistics database, and socioeconomic and welfare information from the Institute of Applied Economic Research. Moving averages were calculated, disaggregated by capital city and municipality. The annual percent change in mortality rates was estimated by segmented linear regression using the joinpoint method. Pearson’s correlation coefficients were conducted between average mortality rate at the end of the three-year period and selected indicators in the state capital and each Brazilian state.

RESULTS

There was a decline in cervical cancer mortality rates throughout the period studied, except in municipalities outside of the capitals in the North and Northeast. There was a decrease in breast cancer mortality in the capitals from the end of the 1990s onwards. Favorable socioeconomic indicators were inversely correlated with cervical cancer mortality. A strong direct correlation was found with favorable indicators and an inverse correlation with fertility rate and breast cancer mortality in inner cities.

CONCLUSIONS

There is an ongoing dynamic process of increased risk of cervical and breast cancer and attenuation of mortality because of increased, albeit unequal, access to and provision of screening, diagnosis and treatment.

Breast Neoplasms, mortality; Uterine Cervical Neoplasms, mortality; Health Services Accessibility; Time Series Studies

Region	Municipalities	Trend 1
Region	Municipalities	Years	APC	95%CI
North	Capitals	1980 to 2010	-1.8	-2.0;-1.6
	Other municipalities	1980 to 2010	1.7	1.2;2.2
Northeast	Capitals	1980 to 2010	-3.3	-3.5;-3.1
	Other municipalities	1980 to 2010	1.0	0.8;1.3
Southeast	Capitals	1980 to 2010	-1.9	-2.2;-1.7
	Other municipalities	1980 to 2010	-2.2	-2.5;-2.0
South	Capitals	1980 to 2010	-2.7	-3.1;-2.2
	Other municipalities	1980 to 2010	-1.8	-2.1;-1.4
Central-West	Capitals	1980 to 2010	-3.1	-3.4;-2.8
	Other municipalities	1980 to 2010	-1.1	-1.6;-0.6
Brazil	Capitals	1980 to 2010	-2.2	-2.4;-2.0
	Other municipalities	1980 to 2010	-1.0	-1.2;-0.9

Region	Municipalities	Trend 1			Trend 2			Trend 3

		Years	APC	95%CI	Years	APC	95%CI	Years	APC	95%CI
North	Capitals	1980 to 1984	-2.1	-7.3;3.4	1984 to 2010	1.0	0.6;1.3	–	–	–
	Other municipalities	1980 to 1999	3.1	2.4;3.9	1999 to 2010	5.0	3.3;6.8	–	–	–
Northeast	Capitals	1980 to 1992	0.4	-0.3;1.1	1992 to 2010	-0.5	-0.8;-0.1	–	–	–
	Other municipalities	1980 to 1997	1.5	1.2;1.9	1997 to 2010	4.9	4.4;5.5	–	–	–
Southeast	Capitals	1980 to 1997	0.9	0.8;1.0	1997 to 2002	-2.8	-3.7;-1.9	2002 to 2010	-0.6	-0.9;-0.2
	Other municipalities	1980 to 2010	0.6	0.4;0.8	–	–	–	–	–	–
South	Capitals	1980 to 1991	1.6	1.1;2.2	1991 to 2010	-1.3	-1.5;-1.1	–	–	–
	Other municipalities	1980 to 1993	1.9	1.6;2.2	1993 to 2010	-0.2	-0.4;0.0	–	–	–
Central-West	Capitals	1980 to 1996	1.4	1.0;1.8	1996 to 2010	-0.9	-1.4;-0.4	–	–	–
	Other municipalities	1980 to 2010	2.4	2.0;2.8	–	–	–	–	–	–
Brazil	Capitals	1980 to 1997	0.7	0.6;0.8	1997 to 2003	-2.6	-3.2;-1.9	2003 to 2010	0.0	-0.4;0.5
	Other municipalities	1980 to 2010	1.1	1.0;1.2	–	–	–	–	–	–

	Breast cancer				Cervical cancer

Indicators	Capitals		Other municipalities		Capitals		Other municipalities

	Correlation	p	Correlation	p	Correlation	p	Correlation	p
Positive
Human development index (HDI)	0.32	0.0990	0.58	0.0020	-0.38	0.0502	-0.38	0.0585
Doctors (per thousand inhabitants)^a a Ministério da Saúde, Departamento de Informática do Sistema Único de Saúde. Informações das estatísticas de mortalidade e demográficas [cited 2013 Jan]. Available from: www2.datasus.gov.br/DATASUS/index.php?area=02	0.61	0.0008	0.81	< 0.0001	-0.51	0.0084	-0.29	0.1581
% individuals aged ≤ 25 with more than 11 years of schooling	0.51	0.0063	0.78	< 0.0001	-0.57	0.0018	-0.37	0.0636
% individuals in households with electricity	0.36	0.0635	0.71	< 0.0001	-0.17	0.3828	-0.36	0.0745
% individuals in households with plumbing	0.53	0.0047	0.82	< 0.0001	-0.40	0.0404	-0.36	0.0689
Negative
% population aged ≤ 25 who are illiterate	-0.22	0.2764	-0.47	0.0155	0.18	0.3588	0.27	0.1893
Fertility rate (%)	-0.59	0.0013	-0.92	< 0.0001	0.52	0.0056	0.35	0.0754
% individuals living below the poverty line	-0.26	0.1878	-0.62	0.0007	0.45	0.0198	0.46	0.0173
Mortality rate in children < 5 per 1,000 LB	-0.16	0.4283	-0.40	0.0429	0.36	0.0613	0.39	0.0508
% female head of household, single and with children aged ≤ 15	-0.44	0.0223	-0.82	< 0.0001	0.33	0.0895	0.24	0.2421

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[1] Correspondence: Vania Reis Girianelli Av. Brasil, 4365 Manguinhos 21040-360 Rio de Janeiro, RJ, Brasil E-mail: vania.girianelli@ipec.fiocruz.br