Institute of Health Sciences, Federal University of Pará (UFPA), Belém, PA, Brazil.
Medical School Faceres (FACERES), São José do Rio Preto, São Paulo, Brazil.
PLoS One. 2022 Sep 15;17(9):e0274572. doi: 10.1371/journal.pone.0274572. eCollection 2022.
Colorectal cancer (CRC) caused 261,060 deaths in Brazil over a 20-year period, with a tendency to increase over time. This study aimed to verify the sociodemographic factors predicting higher mortality caused by CRC and survival rates. Moreover, we aimed to verify whether the performance of screening, diagnostic and treatment procedures had an impact on mortality. Ecological observational study of mortality due to CRC was conducted in Brazil from 2000-2019. The adjustment variable was age, which was used to calculate the age-standardized mortality rate (ASMR). The exposure variables were number of deaths and ASMR. Outcome variables were age-period-cohort, race classification, marital status, geographic region, and screening, diagnostic, and treatment procedures. Age-period-cohort analysis was performed. ANOVA and Kruskal-Wallis test with post hoc tests were used to assess differences in race classification, marital status, and geographic region. Multinomial logistic regression was used to test for interaction among sociodemographic factors. Survival analysis included Kaplan-Meier plot and Cox regression analysis were performed. Multivariate linear regression was used to test prediction using screening, diagnosis, and treatment procedures. In Brazil, mortality from CRC increased after age 45 years. The highest adjusted mortality rates were found among white individuals and in the South of the country (p < 0.05). Single, married, and widowed northern and northeastern persons had a higher risk of death than legally separated southern persons (p < 0.05). Lower survival rates were observed in brown and legally separated individuals and residents from the North (p < 0.05). An increase in first-line chemotherapy and a decrease in second-line chemotherapy were associated with high mortality in the north (p<0.05). In the south, second-line chemotherapy and abdominoperineal rectal resection were associated with high mortality (p < 0.05). Regional differences in sociodemographic factors and clinical procedures can serve as guidelines for adjusting public health policies.
在 20 年期间，巴西有 261060 人死于结直肠癌（CRC），且死亡率呈上升趋势。本研究旨在验证导致 CRC 死亡率升高的社会人口因素和生存率。此外，我们旨在验证筛查、诊断和治疗程序的执行情况是否对死亡率有影响。对 2000 年至 2019 年期间巴西 CRC 死亡率进行了生态观察研究。调整变量为年龄，用于计算年龄标准化死亡率（ASMR）。暴露变量为死亡人数和 ASMR。结局变量为年龄-时期-队列、种族分类、婚姻状况、地理区域以及筛查、诊断和治疗程序。进行了年龄-时期-队列分析。使用方差分析和 Kruskal-Wallis 检验及事后检验来评估种族分类、婚姻状况和地理区域之间的差异。使用多项逻辑回归检验社会人口因素之间的交互作用。生存分析包括 Kaplan-Meier 图和 Cox 回归分析。使用多元线性回归检验筛查、诊断和治疗程序的预测。在巴西，CRC 死亡率在 45 岁后增加。发现调整后的最高死亡率出现在白种人和该国南部（p<0.05）。北部和东北部的单身、已婚和丧偶者比南部合法分居者死亡风险更高（p<0.05）。棕色和合法分居者以及北方居民的生存率较低（p<0.05）。一线化疗的增加和二线化疗的减少与北部的高死亡率相关（p<0.05）。在南部，二线化疗和腹会阴直肠切除术与高死亡率相关（p<0.05）。社会人口因素和临床程序的区域差异可以作为调整公共卫生政策的指南。
