ABSTRACT
Objetivo. Caracterizar la tendencia de la mortalidad por cáncer en Chile según diferencias por nivel educacional en el período 2000-2010 en la población mayor de 20 años. Métodos. Cálculo de las tasas de mortalidad específica por cáncer ajustadas por edad para diferentes niveles educacionales (NE), para el período 2000-2010. Las tasas obtenidas se analizaron con un modelo de regresión de Poisson, calculando el índice de desigualdad relativa (IDR) y el índice de desigualdad de la pendiente (IDP) para cada año. Resultados. Se registraron 232 541 muertes por cáncer en el período 2000-2010. Los tipos de cáncer más frecuentes fueron de mama, estómago y vesícula biliar en mujeres; y estómago, próstata y pulmón en hombres. Las tasas de mortalidad por cáncer estandarizadas por edad fueron mayores en los NE más bajos, excepto para el de mama en mujer y el de pulmón en hombres. Las mayores diferencias se encontraron en el de vesícula biliar en mujeres y el de estómago en hombres, con mayores tasas de mortalidad específica de hasta 49 y 63 veces respectivamente, para NE bajo respecto al NE alto. Entre 2000 y 2010, las diferencias en mortalidad por NE se redujeron para todos los cánceres combinados en ambos géneros, mama en mujeres, y pulmón y estómago en hombres. Conclusiones. Durante el período estudiado, la mortalidad por cáncer en Chile estuvo fuertemente asociada al NE de la población. Esta información debe ser considerada al definir estrategias nacionales para reducir la mortalidad específica por cáncer en los grupos más desprotegidos.
Objective. Characterize the trends in mortality from cancer in Chile according to differences in educational level in the period 2000-2010 in the population over 20 years of age. Methods. Calculation of specific mortality from cancer, age-adjusted for different educational levels, for the period 2000-2010. The obtained rates were analyzed using a Poisson regression model, calculating the relative inequality index and the slope index of inequality for each year. Results. 232 541 deaths from cancer were reported in the period 2000-2010. The most frequent types were breast, stomach, and gallbladder cancer in women; and stomach, prostate, and lung cancer in men. Age-standardized mortality from cancer was greater in the lower educational levels, except for breast cancer in woman and lung cancer in men. The greatest differences were found in gallbladder cancer in women and stomach cancer in men, with specific mortality rates up to 49 and 63 times higher, respectively, for low educational levels compared to higher ones. Between 2000 and 2010, the differences in mortality by educational level were smaller for all cancers combined in both genders, for breast cancer in women, and for lung and stomach in men. Conclusions. During the period studied, mortality from cancer in Chile was strongly associated with the educational level of the population. This information should be considered when designing national strategies to reduce specific mortality from cancer in the most vulnerable groups.
Subject(s)
Humans , Bronchial Diseases , Bronchography/methods , Radiographic Image Enhancement/methods , Radiography, Thoracic/methods , Tomography, X-Ray Computed/methods , Diagnosis, DifferentialABSTRACT
The increasing concerns of nations to improve efficiency, access and quality of health care, have encouraged a more appropriate use of health interventions. Thus, the interest of clinicians and decision-makers has shifted towards evidence-based medicine, comparative effectiveness research and health technology assessment (HTA). Although these concepts should not be understood as synonyms, they converge on common characteristics: a systematic approach to evidence, the focus on relevant outcomes for the patient, and the notion that policy-making for a group of patients will affect others. As a consequence, concerns not only involve efficiency and effectiveness, but also transparency, clinical practice and opportunity costs. This paper introduces the concept and processes of HTA in the first and second sections. Section three reviews the evolution of HTA in developed and Latin-American countries, analyzing the aspects that influence the structure and scope of HTA. The last section concludes with reflections on the challenges to implement HTA in Chile.