Santamaría-Ulloa Carolina, Valverde-Manzanares Cindy
Health Research Institute, University of Costa Rica, San José, Costa Rica.
Health Surveillance Department, Ministry of Health Costa Rica, San José, Costa Rica.
Front Oncol. 2019 Jan 10;8:664. doi: 10.3389/fonc.2018.00664. eCollection 2018.
Cervical cancer is the third most incident and the fourth most lethal cancer among Costa Rican women. The purpose of this study was to quantify incidence inequality along three decades and to explore its determinants. This is a population-based study. Main data sources were the National Tumor Registry (1980-2010), CRELES (Costa Rican Longevity and Healthy Aging Study) longitudinal survey (2013), and published indices of economic condition (2007) and access to healthcare (2000). Cartography was made with QGIS software. Inequality was quantified using the Theil-T index. With the purpose of detecting differences by tumor's behavior, inequality was estimated for "" and invasive incidence. /Invasive Ratios were estimated as an additional marker of inequality. Poisson and spatial regression analyses were conducted with Stata and ArcMap software, respectively, to assess the association between incidence and social determinants such as economic condition, access to healthcare and sub-utilization of Papanicolaou screening. As measured by Theil-T index, incidence inequality has reached high (83 to 87%) levels during the last three decades. For invasive cervical cancer, inequality has been rising especially in women aged 50-59; increasing from 58% in the 1980's to 66% in 2000's. Poisson regression models showed that sub-utilization of Papanicolaou smear was associated with a significant decrease in the probability of early diagnosis. Costa Rican guidelines establish a Pap smear every 2 years; having a Pap smear every 3 years or longer was associated with a 36% decrease in the probability of early "" diagnosis (IRR = 0.64, = 0.003) in the last decade. Spatial regression models allowed for the detection of specific areas where incidence of invasive cervical cancer was higher than expected. Results from this study provide evidence of inequality in the incidence of cervical cancer, which has been high over three decades, and may be explained by sub-utilization of Papanicolaou smear screening in certain regions. The reasons why women do not adequately use screening must be addressed in future research. Interventions should be developed to stimulate the utilization of screening especially among women aged 50 to 59 where inequality has been rising.
宫颈癌是哥斯达黎加女性中发病率第三高、致死率第四高的癌症。本研究的目的是量化三十年期间的发病率不平等情况，并探究其决定因素。这是一项基于人群的研究。主要数据来源包括国家肿瘤登记处（1980 - 2010年）、CRELES（哥斯达黎加长寿与健康老龄化研究）纵向调查（2013年），以及已公布的经济状况指数（2007年）和医疗保健可及性指数（2000年）。使用QGIS软件制作地图。使用泰尔 - T指数量化不平等情况。为了检测肿瘤行为的差异，对“”和浸润性发病率的不平等情况进行了估计。浸润率被估计为不平等的一个额外指标。分别使用Stata和ArcMap软件进行泊松回归分析和空间回归分析，以评估发病率与社会决定因素之间的关联，如经济状况、医疗保健可及性以及巴氏涂片筛查的未充分利用情况。以泰尔 - T指数衡量，在过去三十年中，发病率不平等已达到较高水平（83%至87%）。对于浸润性宫颈癌，不平等情况尤其在50 - 59岁女性中呈上升趋势；从20世纪80年代的58%增至21世纪头十年的66%。泊松回归模型表明，巴氏涂片检查的未充分利用与早期诊断概率显著降低相关。哥斯达黎加的指南规定每两年进行一次巴氏涂片检查；在过去十年中每三年或更长时间进行一次巴氏涂片检查与早期“”诊断概率降低36%相关（发病率比值比 = 0.64， = 0.003）。空间回归模型能够检测出浸润性宫颈癌发病率高于预期的特定区域。本研究结果提供了宫颈癌发病率不平等的证据，这种不平等在三十年期间一直很高，可能是由于某些地区巴氏涂片筛查的未充分利用所致。女性未充分利用筛查的原因必须在未来研究中加以探讨。应制定干预措施以促进筛查的利用，特别是在不平等情况不断上升的50至59岁女性中。
