Public Health Department, Federal University of Maranhão, São Luís, Maranhão, Brazil.
Department of Electrical Engineering, Federal University of Maranhão, São Luís, Maranhão, Brazil.
PLoS One. 2023 Sep 21;18(9):e0291609. doi: 10.1371/journal.pone.0291609. eCollection 2023.
This study analyzes the effect of the Brazilian National Oral Health Policy (NOHP) on oral cancer mortality rates (OCMR).
This is an ecological study with secondary oral cancer death data, using interrupted time series analysis (ARIMA, Autoregressive Integrated Moving Average). Annual death data were collected from the Mortality Information System (1996-2019). The outcome was the OCMR, standardized by gender and age We considered the NOHP, categorized as "0" (before its implementation), from 1996 to 2004, and "1 to 15", from 2005 to 2019. ARIMA modeling was carried out for temporal analysis, and regression coefficient estimation (RC).
The Brazilian NOHP implementation was associated with an increase in OCMR in the North region (CR = 0.16; p = 0.022) and with a decrease in the Southeast region (CR = -0.04; p<0.001), but did not affect the other macro-regions nor Brazil. The forecast models estimated an increase in OCMR for the North, and Northeast, a decrease for the Southeast, and stability for the South and Brazil.
The Brazilian NOHP is not being effective in reducing the OCMR. The trends behaved differently in the Brazilian territory, highlighting health inequities. We recommend that the NOHP strengthen the oral health care network, incorporating oral cancer as a notifiable disease, adopting strategies for prevention, screening, and providing opportunities for early treatment of the disease.
本研究分析了巴西国家口腔健康政策（NOHP）对口腔癌死亡率（OCMR）的影响。
这是一项具有二次口腔癌死亡数据的生态学研究，使用自回归综合移动平均（ARIMA）进行中断时间序列分析。从死亡信息系统（1996-2019 年）中收集年度死亡数据。结果是 OCMR，按性别和年龄标准化。我们考虑了 NOHP，分为“0”（实施前），从 1996 年到 2004 年，和“1 到 15”，从 2005 年到 2019 年。进行了 ARIMA 建模进行时间分析和回归系数估计（RC）。
巴西 NOHP 的实施与北部地区 OCMR 的增加相关（CR = 0.16；p = 0.022），与东南部地区的减少相关（CR = -0.04；p<0.001），但对其他宏观区域和巴西没有影响。预测模型估计北部和东北部的 OCMR 会增加，东南部会减少，南部和巴西会保持稳定。
巴西的 NOHP 未能有效降低 OCMR。巴西境内的趋势表现不同，突出了健康不平等。我们建议 NOHP 加强口腔卫生保健网络，将口腔癌作为应报告疾病，采取预防、筛查策略，并为早期治疗该疾病提供机会。
