Inequalities in Mortality and Access to Hospital Care for Cervical Cancer—An Ecological Study
Abstract
:1. Background
2. Method
2.1. Data Source
2.2. Procedure for Collecting Data
Deaths from Cervical Cancer
- -
- Access to mortality data was based on the following sequence within the DATASUS system:
- Vital statistics;
- Mortality between 2000 and 2012;
- General mortality;
- Geographical coverage.
- -
- The deaths related to each code were extracted and stratified according to the following variables:
- Age group (from 25 to 64 years, divided into 5-year ranges);
- Location (administrative regions);
- Year (2000 to 2012).
2.3. Resident Population
- Demographic and socioeconomic data;
- Resident population data;
- Censuses (1980, 1991, 2000, and 2010), Count (1996), and intercensorial projections (1981 to 2012) according to age, sex, and domiciliary situation;
- Geographical coverage.
2.4. Cervical Cancer Mortality
2.5. Hospital Admissions for Cervical Cancer
- Region;
- Morbidity list code CID-10 (malignant neoplasm of the cervix);
- Age group.
2.6. Data Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
CC | Cervical cancer |
CACON | Complexity in Oncology Center |
SIM | Information system |
DATASUS | Data from the Department of Informatics of the Unified Health System |
ICD | International Classification of Diseases |
IBGE | Brazilian Institute of Geography and Statistics |
IAH | Hospital Information System (SIH), Hospital Inpatient Authorization |
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Country Regions | Deaths (n) | Age-Standardized Mortality (95% CI) | Hospital Admissions | Age-Standardized Admissions (95% CI) | Proportional Mortality (95% CI) |
---|---|---|---|---|---|
Age group (years) * | |||||
North | |||||
25–29 | 177 | 2.09 (2.08 to 2.09) | 797 | 9.45 (9.44 to 9.46) | 3.55 (3.46 to 3.64) |
30–34 | 375 | 5.22 (5.21 to 5.23) | 1587 | 22.10 (22.08 to 22.11) | 7.12 (6.94 to 7.29) |
35–39 | 496 | 8.24 (8.23 to 8.24) | 2299 | 38.21 (38.18 to 38.25) | 8.89 (8.68 to 9.10) |
40–44 | 677 | 13.59 (13.58 to 13.60) | 2909 | 58.42 (58.37 to 58.48) | 10.61 (10.38 to 10.84) |
45–49 | 770 | 19.24 (19.23 to 19.26) | 2616 | 65.36 (65.29 to 65.42) | 9.61 (9.42 to 9.80) |
50–54 | 704 | 22.62 (22.60 to 22.64) | 1718 | 55.22 (55.15 to 55.29) | 7.61 (7.48 to 7.75) |
55–59 | 617 | 25.37 (25.34 to 25.40) | 1221 | 50.22 (50.15 to 50.29) | 6.19 (6.08 to 6.30) |
60–64 | 529 | 28.47 (28.42 to 28.51) | 918 | 49.41 (49.34 to 49.49) | 4.92 (4.84 to 5.01) |
Northeast | |||||
25–29 | 347 | 1.21 (1.21 to 2.65) | 3595 | 12.55 (12.54 to 12.56) | 2.59 (2.55 to 2.62) |
30–34 | 679 | 2.66 (2.65 to 2.66) | 7206 | 28.23 (28.21 to 28.24) | 4.43 (4.37 to 4.49) |
35–39 | 1083 | 4.81 (4.80 to 4.82) | 12,255 | 54.50 (54.48 to 54.52) | 5.85 (5.78 to 5.93) |
40–44 | 1422 | 7.22 (7.21 to 7.22) | 16,134 | 82.02 (81.98 to 82.05) | 6.00 (5.93 to 6.07) |
45–49 | 1783 | 10.63 (10.62 to 10.64) | 15,222 | 90.81 (90.77 to 90.85) | 5.96 (5.90 to 6.01) |
50–54 | 1719 | 12.28 (12.28 to 12.29) | 9402 | 67.18 (67.14 to 67.22) | 4.91 (4.86 to 4.96) |
55–59 | 1683 | 14.54 (14.53 to 14.55) | 6004 | 51.88 (51.86 to 51.90) | 4.31 (4.27 to 4.34) |
60–64 | 1549 | 15.73 (15.72 to 15.73) | 4887 | 49.64 (49.61 to 49.67) | 3.33 (3.30 to 3.36) |
Southeast | |||||
25–29 | 363 | 0.81 (0.80 to 0.81) | 5508 | 12.37 (12.37 to 12.37) | 1.61 (1.59 to 1.62) |
30–34 | 772 | 1.82 (1.81 to 1.83) | 9593 | 22.70 (22.69 to 22.71) | 2.71 (2.68 to 2.73) |
35–39 | 1244 | 3.13 (3.13 to 3.14) | 14,480 | 36.46 (36.44 to 36.47) | 3.36 (3.33 to 3.38) |
40–44 | 1961 | 5.35 (5.34 to 5.35) | 20,572 | 56.13 (56.11 to 56.14) | 3.83 (3.80 to 3.86) |
45–49 | 2460 | 7.56 (7.55 to 7.57) | 21,140 | 64.99 (64.97 to 65.01) | 3.67 (3.64 to 3.70) |
50–54 | 2576 | 9.43 (9.42 to 9.43) | 15,212 | 55.70 (55.67 to 55.72) | 3.33 (3.31 to 3.34) |
55–59 | 2380 | 10.99 (10.98 to 10.99) | 10,837 | 55.05 (50.02 to 50.08) | 2.91 (2.89 to 2.91) |
60–64 | 2242 | 12.70 (12.69 to 12.71) | 9223 | 52.27 (52.24 to 52.30) | 2.57 (2.55 to 2.58) |
South | |||||
25–29 | 208 | 1.43 (1.42 to 1.43) | 4341 | 29.93 (29.91 to 29.95) | 2.60 (2.55 to 2.66) |
30–34 | 414 | 2.96 (2.95 to 2.97) | 6679 | 47.81 (47.78 to 47.84) | 4.39 (4.31 to 4.47) |
35–39 | 715 | 5.29 (5.28 to 5.29) | 9998 | 73.98 (73.95 to 74.01) | 5.53 (5.44 to 5.61) |
40–44 | 893 | 7.10 (7.09 to 7.10) | 14,092 | 112.17 (112.11 to 112.23) | 5.24 (5.18 to 5.30) |
45–49 | 1115 | 9.90 (9.89 to 9.90) | 15,274 | 135.64 (135.57 to 135.71) | 4.95 (4.89 to 5.00) |
50–54 | 1073 | 11.45 (11.44 to 11.45) | 9969 | 106.41 (106.35 to 106.48) | 4.02 (3.99 to 4.05) |
55–59 | 996 | 13.19 (13.18 to 13.19) | 5722 | 75.83 (75.77 to 75.88) | 3.36 (3.34 to 3.39) |
60–64 | 898 | 14.75 (14.73 to 14.76) | 4390 | 72.14 (72.08 to 72.19) | 2.76 (2.73 to 2.78) |
Central-West | |||||
25–29 | 101 | 1.26 (1.26 to 1.27) | 1155 | 14.41 (14.41 to 14.41) | 2.40 (2.33 to 2.47) |
30–34 | 211 | 2.82 (2.81 to 2.82) | 2167 | 29.02 (28.99 to 29.04) | 3.99 (3.89 to 4.08) |
35–39 | 310 | 4.65 (4.64 to 4.66) | 3503 | 52.58 (52.55 to 52.61) | 4.56 (4.47 to 4.66) |
40–44 | 429 | 7.50 (7.49 to 7.50) | 4706 | 82.33 (82.26 to 82.40) | 5.43 (5.32 to 5.54) |
45–49 | 546 | 11.55 (11.53 to 11.57) | 4255 | 90.02 (89.94 to 90.10) | 5.41 (5.32 to 5.51) |
50–54 | 511 | 13.72 (13.70 to 13.73) | 2565 | 68.87 (68.81 to 68.93) | 4.39 (4.32 to 4.46) |
55–59 | 467 | 16.30 (16.28 to 16.32) | 1555 | 54.29 (54.23 to 54.35) | 3.76 (3.71 to 3.82) |
60–64 | 397 | 17.93 (17.90 to 17.96) | 1269 | 57.33 (57.25 to 57.41) | 3.06 (3.02 to 3.10) |
Brazil | |||||
25–29 | 1196 | 1.14 (1.13 to 1.15) | 15,396 | 14.79 (14.79 to 14.79) | 2.40 (2.39 to 2.42) |
30–34 | 2451 | 2.54 (2.53 to 2.54) | 27,232 | 28.25 (28.24 to 28.25) | 3.99 (3.96 to 4.02) |
35–39 | 3848 | 4.35 (4.34 to 4.36) | 42,535 | 48.12 (48.11 to 48.13) | 4.57 (4.54 to 4.59) |
40–44 | 5382 | 6.76 (6.75 to 6.76) | 58,413 | 73.40 (73.38 to 73.41) | 5.43 (5.40 to 5.45) |
45–49 | 6674 | 9.63 (9.63 to 9.64) | 58,507 | 84.45 (84.44 to 84.47) | 5.41 (5.38 to 5.43) |
50–54 | 6583 | 11.44 (11.43 to 11.45) | 38,866 | 67.58 (67.56 to 67.60) | 4.40 (4.38 to 4.41) |
55–59 | 6143 | 13.33 (13.32 to 13.33) | 25,339 | 55.01 (55.00 to 55.03) | 3.77 (3.75 to 3.78) |
60–64 | 5615 | 14.91 (14.90 to 14.91) | 20,687 | 54.95 (54.94 to 54.97) | 3.07 (3.06 to 3.08) |
Country Regions | Linear Regression Mortality | Linear Regression Admissions | ||||
---|---|---|---|---|---|---|
β | p * | r2 | β | p * | r2 | |
Age group (years) * | ||||||
North | ||||||
25–29 | 0.03 | 0.38 | 0.07 | −0.27 | 0.135 | 0.19 |
30–34 | 0.12 | 0.148 | 0.18 | −0.72 | 0.025 | 0.37 |
35–39 | 0.17 | 0.229 | 0.12 | −2.14 | 0.001 | 0.63 |
40–44 | 0.44 | 0.036 | 0.34 | −2.45 | 0.026 | 0.38 |
45–49 | 0.83 | 0.015 | 0.43 | −2.58 | 0.031 | 0.36 |
50–54 | 0.28 | 0.246 | 0.12 | 0.09 | 0.926 | 0.01 |
55–59 | 0.80 | 0.071 | 0.26 | 1.23 | 0.108 | 0.21 |
60–64 | 0.67 | 0.014 | 0.43 | 1.71 | 0.072 | 0.26 |
Northeast | ||||||
25–29 | 0.05 | 0.031 | 0.35 | −0.05 | 0.838 | 0.01 |
30–34 | 0.11 | 0.001 | 0.64 | −0.56 | 0.193 | 0.15 |
35–39 | 0.12 | 0.039 | 0.33 | −1.64 | 0.048 | 0.30 |
40–44 | 0.05 | 0.241 | 0.12 | −2.30 | 0.078 | 0.26 |
45–49 | 0.19 | 0.007 | 0.49 | −2.56 | 0.124 | 0.20 |
50–54 | 0.23 | 0.150 | 0.17 | −2.06 | 0.046 | 0.31 |
55–59 | 0.38 | 0.014 | 0.43 | −1.20 | 0.060 | 0.29 |
60–64 | 0.29 | 0.011 | 0.46 | −1.13 | 0.059 | 0.28 |
Southeast | ||||||
25–29 | 0.01 | 0.088 | 0.24 | −0.08 | 0.692 | 0.02 |
30–34 | 0.03 | 0.108 | 0.22 | −0.40 | 0.027 | 0.37 |
35–39 | −0.03 | 0.191 | 0.15 | −1.62 | <0.001 | 0.89 |
40–44 | −0.12 | 0.001 | 0.65 | −3.23 | <0.001 | 0.94 |
45–49 | −0.26 | <0.001 | 0.72 | −4.03 | <0.001 | 0.88 |
50–54 | −0.30 | 0.007 | 0.49 | −2.95 | <0.001 | 0.82 |
55–59 | −0.38 | <0.001 | 0.81 | −2.33 | <0.001 | 0.78 |
60–64 | −0.56 | <0.001 | 0.85 | −2.31 | <0.001 | 0.84 |
South | ||||||
25–29 | 0.03 | 0.350 | 0.08 | −0.34 | 0.656 | 0.02 |
30–34 | 0.01 | 0.836 | 0.04 | −0.44 | 0.546 | 0.03 |
35–39 | −0.01 | 0.894 | 0.01 | −2.21 | 0.066 | 0.27 |
40–44 | −0.28 | 0.001 | 0.62 | −5.90 | 0.024 | 0.38 |
45–49 | −0.49 | <0.001 | 0.84 | −8.87 | 0.025 | 0.37 |
50–54 | −0.59 | 0.001 | 0.63 | −6.26 | 0.045 | 0.32 |
55–59 | −0.53 | 0.001 | 0.68 | −3.89 | 0.014 | 0.44 |
60–64 | −0.39 | 0.003 | 0.56 | −1.43 | 0.236 | 0.12 |
Central-west | ||||||
25–29 | −0.01 | 0.814 | 0.01 | −0.47 | 0.008 | 0.48 |
30–34 | 0.10 | 0.088 | 0.24 | −1.37 | <0.001 | 0.80 |
35–39 | 0.08 | 0.188 | 0.15 | −3.15 | <0.001 | 0.79 |
40–44 | −0.02 | 0.790 | 0.01 | −4.55 | 0.001 | 0.68 |
45–49 | −0.22 | 0.381 | 0.07 | −6.07 | <0.001 | 0.79 |
50–54 | −0.11 | 0.650 | 0.01 | −3.21 | <0.001 | 0.85 |
55–59 | −0.36 | 0.131 | 0.19 | −1.82 | 0.004 | 0.54 |
60–64 | −0.36 | 0.333 | 0.08 | −1.12 | 0.159 | 0.18 |
Brazil | ||||||
25–29 | 0.03 | 0.006 | 0.50 | −0.16 | 0.505 | 0.04 |
30–34 | 0.06 | 0.001 | 0.64 | −0.58 | 0.047 | 0.31 |
35–39 | 0.03 | 0.115 | 0.21 | −1.89 | <0.001 | 0.71 |
40–44 | −0.05 | 0.092 | 0.23 | −3.43 | 0.001 | 0.68 |
45–49 | −0.11 | 0.087 | 0.24 | −4.49 | 0.001 | 0.63 |
50–54 | −0.16 | 0.023 | 0.39 | −3.14 | 0.003 | 0.57 |
55–59 | −0.15 | 0.050 | 0.31 | −2.08 | 0.002 | 0.60 |
60–64 | −0.24 | 0.001 | 0.66 | −1.57 | 0.001 | 0.64 |
Brazil/Regions | Age-Standardized Mortality * (95% CI) by Cervical Cancer † (×100,000 Inhabitants) | Linear Regression | ||||||||||||||
2000 | 2001 | 2002 | 2003 | 2004 | 2005 | 2006 | 2007 | 2008 | 2009 | 2010 | 2011 | 2012 | β | p | r2 | |
North | 4.09 (4.08; 4.10) | 5.20 (5.19; 5.20) | 6.28 (6.27; 6.29) | 6.21 (6.21; 6.22) | 7.32 (7.31; 7.33) | 7.07 (7.06; 7.08) | 7.40 (7.39; 7.41) | 5.84 (5.83; 5.85) | 7.22 (7.21; 7.22) | 7.38 (7.37; 7.38) | 6.88 (6.87; 6.88) | 6.93 (6.92; 6.93) | 7.39 (7.38; 7.39) | 0.18 | 0.008 | 0.48 |
Northeast | 2.85 (2.84; 2.86) | 3.10 (3.09; 3.10) | 3.40 (3.39; 3.40) | 3.28 (3.27; 3.29) | 3.61 (3.60; 3.61) | 3.92 (3.92; 3.93) | 4.07 (4.06; 4.07) | 3.75 (3.74; 3.75) | 3.84 (3.83; 3.84) | 4.00 (3.99; 4.00) | 3.62 (3.61; 3.62) | 3.73 (3.72; 3.74) | 4.12 (4.12; 4.13) | 0.07 | 0.002 | 0.61 |
Southeast | 3.17 (3.16; 3.17) | 3.21 (3.21; 3.22) | 2.97 (2.96; 2.97) | 3.04 (3.04; 3.05) | 3.28 (3.27; 3.28) | 2.83 (2.82; 2.83) | 2.69 (2.69; 2.70) | 2.46 (2.46; 2.47) | 2.44 (2.44; 2.45) | 2.37 (2.36; 2.37) | 2.47 (2.46; 2.48) | 2.51 (2.51; 2.52) | 2.41 (2.41; 2.42) | −0.07 | <0.001 | 0.79 |
South | 4.03 (4.02; 4.04) | 4.62 (4.61; 4.62) | 3.95 (3.95; 3.96) | 4.08 (4.08; 4.09) | 3.99 (3.98; 3.99) | 3.78 (3.78; 3.79) | 3.59 (3.58; 3.59) | 3.14 (3.13; 3.15) | 3.27 (3.26; 3.28) | 3.10 (3.09; 3.10) | 3.02 (3.01; 3.02) | 3.14 (3.13; 3.14) | 3.25 (3.25; 3.25) | −0.11 | <0.001 | 0.79 |
Central-west | 4.03 (4.02; 4.04) | 3.81 (3.80; 3.81) | 3.50 (3.49; 3.51) | 4.57 (4.57; 4.58) | 4.61 (4.61; 4.61) | 4.68 (4.67; 4.69) | 4.53 (4.53; 4.54) | 3.89 (3.89; 3.90) | 3.81 (3.81; 3.81) | 3.89 (3.89; 3.89) | 4.04 (4.03; 4.05) | 3.49 (3.48; 3.49) | 3.59 (3.58; 3.59) | −0.03 | 0.270 | 0.10 |
Brazil | 3.34 (3.33; 3.35) | 3.57 (3.57; 3.58) | 3.45 (3.45; 3.45) | 3.55 (3.55; 3.56) | 3.78 (3.77; 3.78) | 3.62 (3.61; 3.63) | 3.56 (3.55; 3.56) | 3.17 (3.17; 3.17) | 3.29 (3.29; 3.30) | 3.28 (3.27; 3.28) | 3.22 (3.21; 3.23) | 3.26 (3.25; 3.26) | 3.36 (3.35; 3.37) | −0.02 | 0.065 | 0.27 |
Brazil/Regions | Age-Standardized Incidence * (95% CI) of Hospital Admissions for Cervical Câncer (× 100,000 Inhabitants) | Linear Regression | ||||||||||||||
2000 | 2001 | 2002 | 2003 | 2004 | 2005 | 2006 | 2007 | 2008 | 2009 | 2010 | 2011 | 2012 | β | p | r2 | |
North | 17.56 (17.54; 17.58) | 18.32 (18.29; 18.35) | 20.39 (20.37; 20.41) | 24.03 (24.01; 24.06) | 28.24 (28.20; 28.280 | 25.64 (25.61; 25.68) | 22.51 (22.49; 22.53) | 22.03 (22.01; 22.06) | 20.02 (19.99; 20.04) | 18.36 (18.35; 18.37) | 15.49 (15.47; 15.50) | 15.99 (15.98; 16.01) | 16.13 (16.12; 16.14) | −0.42 | 0.157 | 0.17 |
Northeast | 24.60 (24.59; 24.61) | 21.37 (21.36; 21.39) | 29.20 (29.19; 29.21) | 37.77 (37.75; 37.80) | 32.87 (32.86; 32.89) | 27.79 (27.77; 27.81) | 29.22 (29.21; 29.23) | 26.10 (26.08; 26.11) | 25.70 (25.68; 25.71) | 23.51 (23.49; 23.53) | 20.72 (20.71; 20.73) | 20.34 (20.32; 20.35) | 20.33 (20.32; 20.35) | −0.67 | 0.080 | 0.25 |
Southeast | 24.08 (24.06; 24.09) | 24.16 (24.15; 24.18) | 26.24 (26.23; 26.25) | 25.18 (25.16; 25.19) | 22.59 (22.57; 22.60) | 22.84 (22.82; 22.85) | 21.94 (21.94; 21.95) | 19.00 (18.99; 19.00) | 17.10 (17.09; 17.10) | 16.41 (16.40; 16.42) | 16.93 (16.93; 16.94) | 15.04 (15.04; 15.05) | 15.62 (15.61; 15.62) | −0.95 | <0.001 | 0.88 |
South | 33.98 (33.95; 34.01) | 30.81 (30.79; 30.84) | 53.69 (53.65; 53.73) | 54.81 (54.76; 54.86) | 53.45 (53.40; 53.50) | 55.37 (55.32; 55.42) | 50.34 (50.30; 50.37) | 40.54 (40.51; 40.57) | 31.93 (31.90; 31.95) | 29.82 (29.79; 29.84) | 28.32 (28.29; 28,35) | 26.45 (26.44; 26.46) | 24.78 (24.76; 24.79) | −1.43 | 0.236 | 0.12 |
Central-west | 36.96 (36.92; 37.00) | 36.72 (36.67; 36.77) | 28.04 (28.00; 28.08) | 31.21 (31.24; 31.24) | 28.38 (28.34; 28.41) | 27.09 (27.06; 27.13) | 29.31 (29.27; 29.34) | 22.09 (22.06; 22.11) | 24.13 (24.10; 24.15) | 24.99 (24.97; 25.02) | 22.70 (22.67; 22.72) | 20.17 (20.15; 20.19) | 19.34 (19.32; 19.36) | −1.33 | <0.001 | 0.84 |
Brazil | 26.31 (26.30; 26.32) | 25.07 (25.06; 25.07) | 31.16 (31.15; 31.17) | 33.36 (33.35; 33.38) | 30.75 (30.74; 30.75 | 29.65 (29.64; 29.65) | 28,74 (28.74; 28.75) | 24.51 (24.50; 24.52) | 22.20 (22.19; 22.20) | 20.97 (20.97; 20.97) | 19.90 (19.89; 19.90) | 18.54 (18.53; 18.54) | 18.48 (18.48; 18.48) | −1.01 | 0.002 | 0.59 |
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Sousa, L.V.d.A.; Maciel, E.d.S.; da Silva Paiva, L.; Alcantara, S.d.S.A.; Nascimento, V.B.d.; Fonseca, F.L.A.; Adami, F. Inequalities in Mortality and Access to Hospital Care for Cervical Cancer—An Ecological Study. Int. J. Environ. Res. Public Health 2021, 18, 10966. https://doi.org/10.3390/ijerph182010966
Sousa LVdA, Maciel EdS, da Silva Paiva L, Alcantara SdSA, Nascimento VBd, Fonseca FLA, Adami F. Inequalities in Mortality and Access to Hospital Care for Cervical Cancer—An Ecological Study. International Journal of Environmental Research and Public Health. 2021; 18(20):10966. https://doi.org/10.3390/ijerph182010966
Chicago/Turabian StyleSousa, Luiz Vinicius de Alcantara, Erika da Silva Maciel, Laércio da Silva Paiva, Stefanie de Sousa Antunes Alcantara, Vânia Barbosa do Nascimento, Fernando Luiz Affonso Fonseca, and Fernando Adami. 2021. "Inequalities in Mortality and Access to Hospital Care for Cervical Cancer—An Ecological Study" International Journal of Environmental Research and Public Health 18, no. 20: 10966. https://doi.org/10.3390/ijerph182010966