巴西女性乳腺癌负担的不平等：1990-2017 年。

Inequalities in the burden of female breast cancer in Brazil, 1990-2017.

机构信息

Graduate Program in Public Health, Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, Minas Gerais, Brazil.

Department of Maternal and Child Nursing and Public Health, Nursing School, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil.

出版信息

Popul Health Metr. 2020 Sep 30;18(Suppl 1):8. doi: 10.1186/s12963-020-00212-5.

BACKGROUND

Breast cancer is the most frequently diagnosed cancer in women and the leading cause of cancer death among females worldwide. In recent decades, breast cancer death rates have been stable or decreasing in more developed regions; however, this has not been observed in less developed regions. This study aims to evaluate inequalities in the burden of female breast cancer in Brazil including an analysis of interregional and interstate patterns in incidence, mortality and disability-adjusted life years (DALYs) rates from 1990 to 2017, and mortality-to-incidence ratio (MIR), and their association with the Socio-demographic Index (SDI).

METHODS

Using estimates from the global burden of disease (GBD) study, we applied a spatial exploratory analysis technique to obtain measurements of global and local spatial correlation. Percentage changes of breast cancer incidence, mortality, and DALYs rates between 1990 and 2017 were calculated, and maps were developed to show the spatial distribution of the variables. Spatial panel models were adjusted to investigate the association between rates and SDI in Brazilian states.

RESULTS

In Brazil, while breast cancer mortality rate have had modest reduction (-4.45%; 95% UI: -6.97; -1.76) between 1990 and 2017, the incidence rate increased substantially (+39.99%; 95% UI: 34.90; 45.39). Breast cancer incidence and mortality rates in 1990 and 2017 were higher in regions with higher SDI, i.e., the most developed ones. While SDI increased in all Brazilian states between 1990 and 2017, notably in less developed regions, MIR decreased, more notably in more developed regions. The SDI had a positive association with incidence rate and a negative association with MIR.

CONCLUSION

Such findings suggest an improvement in breast cancer survival in the period, which may be related to a broader access to diagnostic methods and treatment. This study also revealed the inequality in breast cancer outcomes among Brazilian states and may guide public policy priorities for disease control in the country.

背景

乳腺癌是女性最常见的癌症，也是全球女性癌症死亡的主要原因。近几十年来，在较发达地区，乳腺癌死亡率保持稳定或下降；然而，在欠发达地区却没有观察到这种情况。本研究旨在评估巴西女性乳腺癌负担的不平等，包括分析 1990 年至 2017 年发病率、死亡率和伤残调整生命年（DALYs）率的地区间和州际模式，以及死亡率与发病率比（MIR），并将其与社会人口指数（SDI）相关联。

方法

利用全球疾病负担（GBD）研究的估计数，我们应用空间探索性分析技术获得全球和局部空间相关性的度量。计算了乳腺癌发病率、死亡率和 DALYs 率在 1990 年至 2017 年间的变化百分比，并绘制了地图以显示变量的空间分布。调整空间面板模型以调查巴西各州之间的比率与 SDI 的关联。

结果

在巴西，1990 年至 2017 年间，乳腺癌死亡率适度下降（-4.45%；95%置信区间：-6.97；-1.76），而发病率则大幅上升（39.99%；95%置信区间：34.90；45.39）。1990 年和 2017 年，SDI 较高的地区（即最发达地区）乳腺癌发病率和死亡率更高。尽管 1990 年至 2017 年间，所有巴西州的 SDI 均有所增加，尤其是欠发达地区，但 MIR 下降，更发达地区更为显著。SDI 与发病率呈正相关，与 MIR 呈负相关。