Postgraduate Program in Health Sciences, State University of Maringa, Maringa, Parana, Brazil.
Duke Global Health Institute, Duke University, Durhan, North Carolina, United States of America.
PLoS One. 2023 Jun 23;18(6):e0287371. doi: 10.1371/journal.pone.0287371. eCollection 2023.
Lung cancer (LC) is one of the main causes of mortality in Brazil; geographic, cultural, socioeconomic and health access factors can affect the development of the disease. We explored the geospatial distribution of LC mortality, and associated factors, between 2015 and 2019, in Parana state, Brazil.
We obtained mortality (from the Brazilian Health Informatics Department) and population rates (from the Brazilian Institute of Geography and Statistics [IBGE]) in people over 40 years old, accessibility of oncology centers by municipality, disease diagnosis rate (from Brazilian Ministry of Health), the tobacco production rate (IBGE) and Parana Municipal Performance Index (IPDM) (from Parana Institute for Economic and Social Development). Global Moran's Index and Local Indicators of Spatial Association were performed to evaluate the spatial distribution of LC mortality in Parana state. Ordinary Least Squares Regression and Geographically Weighted Regression were used to verify spatial association between LC mortality and socioeconomic indicators and health service coverage. A strong spatial autocorrelation of LC mortality was observed, with the detection of a large cluster of high LC mortality in the South of Parana state. Spatial regression analysis showed that all independent variables analyzed were directly related to LC mortality by municipality in Paraná.
There is a disparity in the LC mortality in Parana state, and inequality of socioeconomic and accessibility to health care services could be associated with it. Our findings may help health managers to intensify actions in regions with vulnerability in the detection and treatment of LC.
肺癌（LC）是巴西主要死亡原因之一；地理、文化、社会经济和卫生保健获取因素都可能影响疾病的发展。我们探讨了巴西巴拉那州 2015 年至 2019 年期间 LC 死亡率的地理空间分布及其相关因素。
我们获取了年龄在 40 岁以上人群的死亡率（来自巴西卫生信息学部）和人口比例（来自巴西地理与统计研究所[IBGE]）、各市政当局的肿瘤中心可达性、疾病诊断率（来自巴西卫生部）、烟草产量（IBGE）和巴拉那州绩效指数（IPDM）（来自巴拉那州经济和社会发展研究所）。我们还进行了全局 Moran 指数和局部空间关联指标分析，以评估巴拉那州 LC 死亡率的空间分布。我们还使用普通最小二乘回归和地理加权回归来验证 LC 死亡率与社会经济指标和卫生服务覆盖之间的空间关联。结果显示，LC 死亡率存在很强的空间自相关，在巴拉那州南部发现了一个 LC 死亡率高的大型集群。空间回归分析表明，在所分析的所有自变量中，在巴拉那州的各个市政当局中，均与 LC 死亡率呈直接相关。
巴拉那州的 LC 死亡率存在差异，社会经济不平等和获得卫生保健服务的不平等可能与之相关。我们的研究结果可能有助于卫生管理人员在 LC 检测和治疗方面存在脆弱性的地区加强行动。
