Impacts of Sociodemographic Factors, Screening, and Organization of Health Services on Breast Cancer Mortality in Brazil: An Ecological Study of 20 Years.

Background: Breast cancer mortality is increasing in Brazil. This study examines the impact of sociodemographic factors, screening procedures, and primary healthcare (PHC) on breast cancer mortality. Methods: An ecological study analyzed secondary data of women diagnosed with breast cancer who died between 2000 and 2019. Sociodemographic factors, screening procedures, and PHC were examined in relation to breast cancer mortality. Statistical analyses included normality tests, Kruskal-Wallis and one-way ANOVA tests with post hoc comparisons, Pearson and Spearman correlation tests, age-period-cohort analysis, Kaplan-Meier analysis, and Cox regression analysis. Significance was set at p < 0.05. Results: Mortality rates were higher in the southeast (15.77) and south (15.97) regions compared to the north (5.07) (p < 0.0001). Survival rates were longer in the southeast (70.3 ± 0.05) and south (70.6 ± 0.09) than in the north (63.98 ± 0.053) (p ≤ 0.001). Mortality increased with age after 32 years (p ≤ 0.001). Brown and indigenous women had lower mortality and survival rates. Increased coverage of PHC, ultrasound, and biopsy did not reduce mortality. However, improved cytopathologic analysis led to a decrease in mortality. Conclusions: Sociodemographic factors, screening procedures, and PHC are specific predictors of breast cancer mortality in Brazil.

Influence of social, demographic, and clinical factors in live births with spinal dysraphism in Brazil: an ecological study of 21 years.

OBJECTIVES: This study aimed to verify possible associations between sociodemographic and clinical factors in live births with spinal dysraphism. METHODS: An analytical (descriptive and inferential) and ecological study was carried out based on secondary data of 11,308 live births with spinal dysraphism registered in the Live Birth Information System (SINASC) in Brazil from 1999 to 2019. Demographic factors analyzed were age, education, mothers' marital status and geographic region. The clinical factors analyzed were duration, gestation period, birthweight, and number of prenatal visits performed by women who underwent medical follow-up. RESULTS: There was an increase in the number of cases of spinal dysraphism in recent years in Brazil with an annual percentage variation of 3.52%. However, the period from 2005 to 2009 showed a reduction in live births with spinal dysraphism. The regions with the highest incidence were the South and Southeast. The risk increased in mothers born after 1980, older than 30 years and with a high level of education. The risk was increased in live births of whites and blacks, born from double pregnancy and with body weight less than 3000 g. The absence of prenatal care was associated with a higher incidence. CONCLUSION: Sociodemographic and clinical factors have specific characteristics that can predict spinal dysraphism in newborns in Brazil.

Impact of sociodemographic factors and screening, diagnosis, and treatment strategies on colorectal cancer mortality in Brazil: A 20-year ecological study.

Colorectal cancer (CRC) caused 261,060 deaths in Brazil over a 20-year period, with a tendency to increase over time. This study aimed to verify the sociodemographic factors predicting higher mortality caused by CRC and survival rates. Moreover, we aimed to verify whether the performance of screening, diagnostic and treatment procedures had an impact on mortality. Ecological observational study of mortality due to CRC was conducted in Brazil from 2000-2019. The adjustment variable was age, which was used to calculate the age-standardized mortality rate (ASMR). The exposure variables were number of deaths and ASMR. Outcome variables were age-period-cohort, race classification, marital status, geographic region, and screening, diagnostic, and treatment procedures. Age-period-cohort analysis was performed. ANOVA and Kruskal-Wallis test with post hoc tests were used to assess differences in race classification, marital status, and geographic region. Multinomial logistic regression was used to test for interaction among sociodemographic factors. Survival analysis included Kaplan-Meier plot and Cox regression analysis were performed. Multivariate linear regression was used to test prediction using screening, diagnosis, and treatment procedures. In Brazil, mortality from CRC increased after age 45 years. The highest adjusted mortality rates were found among white individuals and in the South of the country (p < 0.05). Single, married, and widowed northern and northeastern persons had a higher risk of death than legally separated southern persons (p < 0.05). Lower survival rates were observed in brown and legally separated individuals and residents from the North (p < 0.05). An increase in first-line chemotherapy and a decrease in second-line chemotherapy were associated with high mortality in the north (p<0.05). In the south, second-line chemotherapy and abdominoperineal rectal resection were associated with high mortality (p < 0.05). Regional differences in sociodemographic factors and clinical procedures can serve as guidelines for adjusting public health policies.

Mortality from cervical cancer in Brazil: an ecological epidemiologic study of a 22-year analysis.

Mortality data obtained from the mortality information system (SIM) identified a total of 103,094 women with cervical cancer in Brazil. However, associations between mortality and sociodemographic variables in these patients are not fully understood. Therefore, this study aimed to analyse the sociodemographic factors (geographic region, age, race and marital status) that predict cervical cancer mortality in Brazil between 1996 and 2017. A descriptive, analytic and retrospective study was carried out using secondary data on deaths from cervical cancer recorded in the SIM-DATASUS. Deaths reported between 1996 and 2017 in the health information system and classified by the International Classification of Diseases-10 were included. Sociodemographic factors (geographic regions, age, sex and race) were subjected to inferential analysis for a relation with mortality. Mortality increases during the aging process after the third decade of life. However, single women who die are usually diagnosed with cancer in the early stage of the disease. The mortality rate is higher in Black women and women living in the North, South and Southeast regions of Brazil. Yellow women have a lower mortality in the country. Besides, each region has specific characteristics in relation to race and marital status. White women who died had some form of stable union during life, whereas the other races were more associated with single marital status. Thus, the sociodemographic factors that predict mortality in women with cervical cancer in Brazil were identified and can be used to guide the public health policies.

Mortality prediction in women with corpus uteri cancer in Brazil: a 21-year analysis.

Mortality data obtained from the Mortality Information System identified a total of 19,499 deaths in women caused by corpus uteri cancer in Brazil. However, the association between mortality and sociodemographic factors in these women is not fully understood. A study based on the secondary data on deaths caused by corpus uteri cancer recorded in the SIM-DATASUS was conducted. Deaths reported from 1996 to 2016 in the health information system were included. Sociodemographic factors were analysed to determine their association with mortality. Low schooling is highly associated with mortality in all administrative regions. Advanced age, race and marital status have specific association with mortality for the different geographic regions. Black, Brown and Indigenous women with low schooling and of advanced age are highly associated with mortality. Brown, White and Black women of advanced age had the highest corpus uteri cancer related mortality rates. Women with low schooling who died of corpus uteri cancer were either single or widows. The marital status of Black, White and Brown women aged <59 years was single. The sociodemographic factors that predict mortality in women with corpus uteri cancer in Brazil were presented and can be used to guide public health.