Health School, Federal University of Rio Grande do Norte, Natal 59078-970, Brazil.
School of Public Health, University of São Paulo, São Paulo 01246-904, Brazil.
Int J Environ Res Public Health. 2022 May 5;19(9):5591. doi: 10.3390/ijerph19095591.
Cervical cancer is a public health issue with high disease burden and mortality in Brazil. The objectives of the present study were, firstly, to analyze age, period, and cohort effects on cervical cancer mortality in women 20 years old or older from 1980 to 2019 in the North, South, and Southeast Regions of Brazil; and secondly, to evaluate whether the implementation of a national screening program and the expansion of access to public health services impacted the examined period and reduced the risk of death compared with previous years and among younger cohorts. The effects were estimated by applying Poisson regression models with estimable functions. The highest mortality rate per 100,000 women was found in Amazonas (24.13), and the lowest in São Paulo (10.56). A positive gradient was obtained for death rates as women's age increased. The states in the most developed regions (South and Southeast) showed a reduction in the risk of death in the period that followed the implementation of the screening program and in the cohort from the 1960s onwards. The North Region showed a decreased risk of death only in Amapá (2000-2004) and Tocantins (1995-2004; 2010-2019). The findings indicate that health inequities remain in Brazil and suggest that the health system has limitations in terms of decreasing mortality associated with this type of cancer in regions of lower socioeconomic development.
宫颈癌是巴西公共卫生领域的一个重大问题，具有较高的疾病负担和死亡率。本研究的目的首先是分析 1980 年至 2019 年期间巴西北部、南部和东南部 20 岁及以上女性宫颈癌死亡率的年龄、时期和队列效应；其次是评估国家筛查计划的实施和公共卫生服务的扩大是否对所研究的时期产生影响，并与前几年相比降低了死亡风险，以及对年轻队列的影响。通过应用可估计函数的泊松回归模型来估计影响。每 10 万名女性中死亡率最高的是亚马逊州（24.13），最低的是圣保罗州（10.56）。随着女性年龄的增长，死亡率呈正梯度上升。在实施筛查计划后的时期以及 20 世纪 60 年代以后出生的队列中，较发达地区（南部和东南部）的州死亡率风险降低。北部地区仅在阿马帕州（2000-2004 年）和托坎廷斯州（1995-2004 年和 2010-2019 年）显示出死亡风险降低。这些发现表明巴西的健康不平等仍然存在，并表明卫生系统在降低与该类型癌症相关的死亡率方面存在局限性，特别是在社会经济发展水平较低的地区。
