Universidade Federal Fluminense. Faculdade de Medicina. Mestrado Profissional em Saúde Materno Infantil. Niterói, RJ, Brasil.
Universidade Federal Fluminense. Faculdade de Medicina. Niterói, RJ, Brasil.
Rev Saude Publica. 2020 Dec 14;54:139. doi: 10.11606/s1518-8787.2020054002528. eCollection 2020.
To verify the effect of the Pact for Health on premature mortality (30-69 years) attributed to cervical cancer in Brazil and its macroregions, using interrupted time series analysis.
Segmented regression was used to assess "change in level" and "change in trend" in premature mortality rates attributed to cervical cancer considering the post-Pact period (2010-2018), controlling by the pre-Pact period (1998-2006). Understanding the triennium 2007-2009 as essential for the adoption and implementation of the policy, it was excluded from the main modeling, but assessed in the sensitivity analysis.
From 1998 to 2018, there were more than 119,000 deaths due to cervical cancer in women aged 30 to 69 years in Brazil. The Northern region experienced the highest rates (> 20 per 100,000). Comparing with baseline (1998-2006), segmented regression showed a progressive increase in changing trend from cervical cancer deaths in Brazil as a whole (coefficient = 0.513; 95%CI 0.430 to 0.596) and in the Southeast region (coefficient = 0.515; 95%CI 0.358 to 0.674), South region (coefficient = 0.925; 95%CI 0.642 to 1.208), and Midwest region (coefficient = 0.590; 95%CI 0.103 to 1.077). The Northeast region presented the most promising effects with immediate reduction in change level (-0.635; 95%CI -1.177 to -0.092) and progressive reduction in the changing trend of premature deaths (coefficient= -0.151; 95%CI -0.231 to -0.007).
Premature mortality rates due to cervical cancer are high in Brazil and its macroregions. This interrupted time series was not able to reveal the effectiveness of initiatives related to the Pact for Health on premature deaths from cervical cancer nationally and in all macroregions equally. The best results are restricted to the Northeast region.
使用中断时间序列分析验证《健康契约》对巴西及各地区 30-69 岁人群宫颈癌导致的过早死亡率的影响。
采用分段回归分析评估宫颈癌导致的过早死亡率在考虑契约后时期（2010-2018 年）的“水平变化”和“趋势变化”，同时控制契约前时期（1998-2006 年）。由于理解 2007-2009 年是该政策采纳和实施的关键时期，因此将其排除在主要建模之外，但在敏感性分析中进行了评估。
1998 年至 2018 年期间，巴西 30-69 岁女性因宫颈癌导致的死亡人数超过 119,000 人。北部地区的死亡率最高（>20/10 万）。与基线（1998-2006 年）相比，分段回归显示巴西整体（系数=0.513；95%CI 0.430 至 0.596）和东南部（系数=0.515；95%CI 0.358 至 0.674）、南部（系数=0.925；95%CI 0.642 至 1.208）和中西部地区（系数=0.590；95%CI 0.103 至 1.077）宫颈癌死亡的变化趋势呈渐进性增加。东北地区呈现出最有希望的效果，死亡率水平的变化立即下降（-0.635；95%CI -1.177 至 -0.092），过早死亡变化趋势的下降呈渐进性（系数=-0.151；95%CI -0.231 至 -0.007）。
巴西及其各地区宫颈癌导致的过早死亡率较高。本中断时间序列分析未能揭示《健康契约》中与宫颈癌相关的各项举措在全国范围内及所有地区对宫颈癌导致的过早死亡的有效性。最好的结果仅限于东北地区。
