巴西米纳斯吉拉斯州宫颈癌生存的地区不平等。

Regional inequalities in cervical cancer survival in Minas Gerais State, Brazil.

机构信息

Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, Sala 503. Santa Efigênia, Belo Horizonte, Minas Gerais, CEP: 30130-100, Brazil; Departamento de Medicina Social e Preventiva, Faculdade de Medicina, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, Sala 803. Santa Efigênia, Belo Horizonte, Minas Gerais, CEP: 30130-100, Brazil.

出版信息

Cancer Epidemiol. 2021 Apr;71(Pt A):101899. doi: 10.1016/j.canep.2021.101899. Epub 2021 Feb 4.

DOI:10.1016/j.canep.2021.101899

PMID:33548845

Abstract

BACKGROUND

Cervical cancer survival is marked by socioeconomic and demographic inequalities. We investigated differences in survival across health regions in Minas Gerais, Brazil, in cervical cancer patients who underwent treatment in the Brazilian Public Health System.

METHODS

From a database developed through probabilistic and deterministic linkage of data from information systems of the Brazilian Public Health System, we identified cervical cancer cases, diagnosed between 2002 and 2010, who underwent radiation and/or chemotherapy and lived in Minas Gerais, Brazil. Five-year overall and cause-specific survivals were estimated by the Kaplan-Meier method and compared using the log-rank test. We used extended Cox models to assess the relationship between the health region of residence and the overall and cause-specific death risk, adjusting for relevant variables.

RESULTS

We included 5613 patients with a median age of 55.0 years. Median follow-up time was 70.0 months. Five-year overall and cause-specific survivals were 56.3 % and 63.6 %, respectively. Across the 13 health regions, 5-year survival ranged from 46.6%-64.2% (p < 0.001) in the overall analysis and from 52.0% to 72.0% (p < 0.001) in the cause-specific analysis. Multivariate models revealed a significantly higher death risk for most health regions in comparison to the reference health region (Norte). Adjustment by age, tumor stage, comorbidity, treatment, travel time, and year of diagnosis had little effect on the association.

CONCLUSION

We found regional disparities in cervical cancer survival that persisted after relevant adjustments. Uneven regional provision of health services might be implicated in these disparities, affecting timely access to treatment for cervical cancer patients.

摘要

背景

宫颈癌的生存状况存在社会经济和人口统计学方面的不平等。我们研究了在巴西米纳斯吉拉斯州接受巴西公共卫生系统治疗的宫颈癌患者在各卫生区域之间的生存差异。

方法

我们通过概率和确定性链接巴西公共卫生系统信息系统中的数据，从数据库中确定了在 2002 年至 2010 年间被诊断患有宫颈癌、接受过放疗和/或化疗并居住在巴西米纳斯吉拉斯州的病例。使用 Kaplan-Meier 方法估计 5 年总生存率和特定原因生存率，并使用对数秩检验进行比较。我们使用扩展 Cox 模型来评估居住地卫生区域与总死亡率和特定原因死亡率之间的关系，同时调整相关变量。

结果

我们纳入了 5613 名中位年龄为 55.0 岁的患者。中位随访时间为 70.0 个月。5 年总生存率和特定原因生存率分别为 56.3%和 63.6%。在 13 个卫生区域中，5 年总生存率从整体分析的 46.6%-64.2%（p<0.001）到特定原因分析的 52.0%-72.0%（p<0.001）不等。多变量模型显示，与参考卫生区域（北）相比，大多数卫生区域的死亡风险显著更高。通过年龄、肿瘤分期、合并症、治疗、旅行时间和诊断年份进行调整对这种关联影响很小。