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[健康不平等:阿根廷科尔多瓦省女性乳腺癌的社会人口学与空间分析]

[Inequities in health: socio-demographic and spatial analysis of breast cancer in women from Córdoba, Argentina].

作者信息

Tumas Natalia, Pou Sonia Alejandra, Díaz María Del Pilar

机构信息

Centro de Investigaciones y Estudios sobre Cultura y Sociedad (CIECS), Universidad Nacional de Córdoba, CONICET, Córdoba, Argentina.

Instituto de Investigaciones en Ciencias de la Salud (INICSA), Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, CONICET, Córdoba, Argentina; Cátedra de Estadística y Bioestadística, Escuela de Nutrición, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, CONICET, Córdoba, Argentina.

出版信息

Gac Sanit. 2017 Sep-Oct;31(5):396-403. doi: 10.1016/j.gaceta.2016.12.011. Epub 2017 Mar 18.

Abstract

OBJECTIVE

To identify sociodemographic determinants associated with the spatial distribution of the breast cancer incidence in the province of Córdoba, Argentina, in order to reveal underlying social inequities.

METHOD

An ecological study was developed in Córdoba (26 counties as geographical units of analysis). The spatial autocorrelation of the crude and standardised incidence rates of breast cancer, and the sociodemographic indicators of urbanization, fertility and population ageing were estimated using Moran's index. These variables were entered into a Geographic Information System for mapping. Poisson multilevel regression models were adjusted, establishing the breast cancer incidence rates as the response variable, and by selecting sociodemographic indicators as covariables and the percentage of households with unmet basic needs as adjustment variables.

RESULTS

In Córdoba, Argentina, a non-random pattern in the spatial distribution of breast cancer incidence rates and in certain sociodemographic indicators was found. The mean increase in annual urban population was inversely associated with breast cancer, whereas the proportion of households with unmet basic needs was directly associated with this cancer.

CONCLUSIONS

Our results define social inequity scenarios that partially explain the geographical differentials in the breast cancer burden in Córdoba, Argentina. Women residing in socioeconomically disadvantaged households and in less urbanized areas merit special attention in future studies and in breast cancer public health activities.

摘要

目的

确定与阿根廷科尔多瓦省乳腺癌发病率空间分布相关的社会人口学决定因素,以揭示潜在的社会不平等现象。

方法

在科尔多瓦省开展了一项生态研究(以26个县作为地理分析单位)。使用莫兰指数估计乳腺癌粗发病率和标准化发病率以及城市化、生育率和人口老龄化等社会人口学指标的空间自相关性。将这些变量输入地理信息系统进行绘图。调整泊松多水平回归模型,将乳腺癌发病率作为响应变量,选择社会人口学指标作为协变量,并将基本需求未得到满足的家庭百分比作为调整变量。

结果

在阿根廷科尔多瓦省,发现乳腺癌发病率的空间分布以及某些社会人口学指标存在非随机模式。城市人口年平均增长率与乳腺癌呈负相关,而基本需求未得到满足的家庭比例与这种癌症呈正相关。

结论

我们的研究结果确定了社会不平等情况,这些情况部分解释了阿根廷科尔多瓦省乳腺癌负担的地理差异。在未来的研究和乳腺癌公共卫生活动中,居住在社会经济弱势家庭和城市化程度较低地区的女性值得特别关注。

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