Correlation of Cervical Cancer Mortality with Fertility, Access to Health Care and Socioeconomic Indicators

Abstract

Objective The present study aimed to examine which development indicators are correlated with cervical cancer (CC) mortality rates in Brazil.

Methods This was an ecological study that correlated mortality rates and indicators, such as human development index (HDI), gross domestic product (GDP) per capita, illiteracy rate, fertility rate, screening coverage, proportion of private health insurance use, density of physicians, and density of radiotherapy centers. The mortality rates were obtained from the Brazilian national registry, while the indicators were based on official reports from the Ministry of Health. Univariate and multivariate linear regression was used.

Results Among the states of Brazil, the average age-specific CC mortality rate from 2008 to 2012 varied from 4.6 to 22.9 per 100,000 women/year. In the univariate analysis, HDI, proportion of private health insurance use, density of physicians, and density of radiotherapy centers were inversely correlated with the mortality rates. Fertility rate was positively correlated with the mortality rates. In the multivariate analysis, only fertility rate was significantly associated with the CC mortality rate (coefficient of correlation: 9.38; 95% confidence interval [CI]: 5.16–13.59).

Conclusion A decrease in the fertility rate, as expected when the level of development of the regions increases, is related to a decrease in the mortality rate of CC. The results of the present study can help to better monitor the quality assessment of CC programs both among and within countries.

Resumo

Objetivo O presente estudo teve como objetivo examinar quais indicadores de desenvolvimento estão correlacionados com as taxas de mortalidade por câncer do colo do útero no Brasil.

Métodos Este foi um estudo ecológico que correlacionou as taxas de mortalidade com indicadores como índice de desenvolvimento humano (IDH), produto interno bruto (PIB) per capita, taxa de analfabetismo, taxa de fertilidade, cobertura do rastreamento, proporção do uso do seguro privado de saúde, densidade de médicos e densidade de centros de radioterapia. A fonte das taxas de mortalidade foi o registro nacional, enquanto que os indicadores foram baseados em relatórios oficiais do Ministério da Saúde. Foi utilizada regressão linear univariada e multivariada.

Resultados Entre os estados, a taxa média de mortalidade específica por idade por câncer do colo do útero de 2008 a 2012 variou de 4.6 a 22.9 por 100.000 mulheres/ano. Na análise univariada, foram inversamente correlacionadas com as taxas de mortalidade: IDH, proporção do uso do seguro privado de saúde, densidade de médicos e densidade de centros de radioterapia. A taxa de fertilidade foi positivamente correlacionada com a mortalidade. Na análise multivariada, apenas a taxa de fertilidade foi significativamente associada à taxa de mortalidade por câncer do colo do útero (coeficiente de correlação: 9,38; índice de confiança [IC] 95%: 5,16–13,59).

Conclusão A diminuição da taxa de fertilidade, como esperado quando o nível de desenvolvimento das regiões aumenta, está relacionada a uma diminuição da taxa de mortalidade por câncer do colo do útero. Os resultados do presente estudo podem ajudar a monitorar melhor a avaliação da qualidade dos programas de câncer do colo do útero nos países tanto interna quanto externamente.

Keywords

cervical cancer - cancer mortality - fertility - human development index - health disparities

Palavras-chave

câncer do colo do útero - mortalidade por câncer - fertilidade - índice de desenvolvimento humano - disparidades em saúde

Contributions

Vale D. B. was involved in all of the steps of the article. Sauvaget C. gave substantial contributions to the interpretation of data, to the writing of the article and to the critical review of the intellectual content. Murillo R. and Zeferino L. C. gave substantial contributions to the critical review of the intellectual content. Muwonge R. gave substantial contributions to the analysis of data and to the critical review of the intellectual content. Sankaranarayanan R. gave substantial contributions to the conception and design and to the critical review of the intellectual content. All of the authors gave the final approval of the version to be published.

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