Universidade de São Paulo. Faculdade de Saúde Pública. Departamento de Epidemiologia. São Paulo, SP, Brasil.
Universidade Nove de Julho. Faculdade de Medicina. Diretoria de Ciências Médicas. São Paulo, SP, Brasil.
Rev Saude Publica. 2020 Dec 16;54:142. doi: 10.11606/s1518-8787.2020054002447. eCollection 2020.
To verify the spatial pattern of mortality from breast and cervical cancer in areas of primary health care, considering socioeconomic conditions.
This is an ecological study, from January 2000 to December 2016. The study area is the municipality of São Paulo, Brazil, and its 456 coverage areas of primary health units. Information on deaths of women aged 20 years or over were geocoded according to residence address. We calculated mortality rates, standardized by age, and smoothed by the local empirical Bayesian method, and grouped into three or two years to reduce the random fluctuation of the data. In addition, bivariate global and local Moran indexes were calculated to verify the existence of spatial agglomeration of standardized mortality rates with a domain of socioeconomic condition, elaborated based on the Índice Paulista de Vulnerabilidade Social (IPVS - São Paulo Index of Social Vulnerability).
The success rate of geocoding was 98.9%. Mortality from breast cancer, without stratification by time, showed a pattern with higher rates located in central regions with better socioeconomic conditions. It showed a decrease at the end of the period and a change in spatial pattern, with increased mortality in peripheral regions. On the other hand, mortality from cervical cancer remained with the highest rates in peripheral regions with worse socioeconomic conditions, despite being reduced over time.
The spatial pattern of mortality from the studied cancers, over time, suggests association with the best socioeconomic conditions of the municipality, either as protection (cervical) or risk (breast). This knowledge may direct resources to prevent and promote health in the territories.
验证初级保健领域乳腺癌和宫颈癌死亡率的空间模式，并考虑社会经济状况。
这是一项生态研究，时间范围为 2000 年 1 月至 2016 年 12 月。研究区域为巴西圣保罗市及其 456 个初级保健单位的覆盖区域。根据居住地址对 20 岁及以上女性的死亡信息进行地理编码。我们计算了死亡率，按年龄标准化，并通过局部经验贝叶斯方法进行平滑处理，然后分为两年或三年组，以减少数据的随机波动。此外，还计算了双变量全局和局部 Moran 指数，以验证标准化死亡率与社会经济条件域的空间集聚是否存在，该条件域是基于 Índice Paulista de Vulnerabilidade Social（IPVS - 圣保罗社会脆弱性指数）构建的。
地理编码的成功率为 98.9%。未按时间分层的乳腺癌死亡率呈现出一种模式，即位于社会经济条件较好的中心区域的死亡率较高。在研究期间结束时，该模式呈下降趋势，且空间模式发生变化，周边区域的死亡率上升。另一方面，宫颈癌死亡率仍然存在，且位于社会经济条件较差的周边区域的死亡率最高，尽管其死亡率随时间有所下降。
随着时间的推移，所研究癌症死亡率的空间模式表明其与本市最佳社会经济条件存在关联，无论是作为保护因素（宫颈癌）还是风险因素（乳腺癌）。这些知识可以指导资源在各地区预防和促进健康。
