Describing mortality trends for major cancer sites in 133 intermediate regions of Brazil and an ecological study of its causes

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Abstract

Background

In Brazil, 211 thousand (16.14%) of all death certificates in 2016 identified cancer as the underlying cause of death, and it is expected that around 320 thousand will receive a cancer diagnosis in 2019. We aimed to describe trends of cancer mortality from 1996 to 2016, in 133 intermediate regions of Brazil, and to discuss macro-regional differences of trends by human development and healthcare provision.

Methods

This ecological study assessed georeferenced official data on population and mortality, health spending, and healthcare provision from Brazilian governmental agencies. The regional office of the United Nations Development Program provided data on the Human Development Index in Brazil. Deaths by misclassified or unspecified causes (garbage codes) were redistributed proportionally to known causes. Age-standardized mortality rates used the world population as reference. Prais-Winsten autoregression allowed calculating trends for each region, sex and cancer type.

Results

Trends were predominantly on the increase in the North and Northeast, whereas they were mainly decreasing or stationary in the South, Southeast, and Center-West. Also, the variation of trends within intermediate regions was more pronounced in the North and Northeast. Intermediate regions with higher human development, government health spending, and hospital beds had more favorable trends for all cancers and many specific cancer types.

Conclusions

Patterns of cancer trends in the country reflect differences in human development and the provision of health resources across the regions. Increasing trends of cancer mortality in low-income Brazilian regions can overburden their already fragile health infrastructure. Improving the healthcare provision and reducing socioeconomic disparities can prevent increasing trends of mortality by all cancers and specific cancer types in Brazilian more impoverished regions.

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Uso da análise de séries temporais em estudos epidemiológicos

José Antunes, Maria Cardoso (2015)

Esse artigo visa introduzir e cativar o interesse sobre a análise de séries temporais em estudos epidemiológicos. São descritos aspectos conceituais desse tipo de análise e sistematizadas indicações metodológicas. Foram definidos os principais conceitos da análise de séries temporais (tendência, variação cíclica e sazonal, associação e variação aleatória), e operacionalizada sua aplicação epidemiológica. Foram apresentados os métodos para avaliação da tendência (porcentagem de modificação anual), baseados em modelos de regressão de Prais-Winsten, e para quantificação da variação sazonal, segundo o modelo de Serfling. Foi, ainda, introduzida a modalidade de análise de regressão segmentada para séries temporais interrompidas, como estratégia de avaliação do efeito de intervenções em saúde.

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40-year trends in an index of survival for all cancers combined and survival adjusted for age and sex for each cancer in England and Wales, 1971-2011: a population-based study.

Manuela Quaresma, Michel Coleman, Bernard Rachet (2015)

Assessment of progress in cancer control at the population level is increasingly important. Population-based survival trends provide a key insight into the overall effectiveness of the health system, alongside trends in incidence and mortality. For this purpose, we aimed to provide a unique measure of cancer survival.

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"Fundamental causes" of social inequalities in mortality: a test of the theory.

Bruce Levin, Bruce G. Link, Jo C. Phelan … (2004)

Medicine and epidemiology currently dominate the study of the strong association between socioeconomic status and mortality. Socioeconomic status typically is viewed as a causally irrelevant "confounding variable" or as a less critical variable marking only the beginning of a causal chain in which intervening risk factors are given prominence. Yet the association between socioeconomic status and mortality has persisted despite radical changes in the diseases and risk factors that are presumed to explain it. This suggests that the effect of socioeconomic status on mortality essentially cannot be understood by reductive explanations that focus on current mechanisms. Accordingly, Link and Phelan (1995) proposed that socioeconomic status is a "fundamental cause" of mortality disparities-that socioeconomic disparities endure despite changing mechanisms because socioeconomic status embodies an array of resources, such as money, knowledge, prestige, power, and beneficial social connections, that protect health no matter what mechanisms are relevant at any given time. We identified a situation in which resources should be less helpful in prolonging life, and derived the following prediction from the theory: For less preventable causes of death (for which we know little about prevention or treatment), socioeconomic status will be less strongly associated with mortality than for more preventable causes. We tested this hypothesis with the National Longitudinal Mortality Study, which followed Current Population Survey respondents (N = 370,930) for mortality for nine years. Our hypothesis was supported, lending support to the theory of fundamental causes and more generally to the importance of a sociological approach to the study of socioeconomic disparities in mortality.

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Author and article information

Contributors

Alessandro Bigoni:

ORCID: http://orcid.org/0000-0002-2483-3299

+55(11)30617968 , alebigoni@usp.br

José Leopoldo Ferreira Antunes:

ORCID: http://orcid.org/0000-0003-3972-9723

leopoldo@usp.br

Elisabete Weiderpass:

ORCID: http://orcid.org/0000-0003-2237-0128

weiderpasse@iarc.fr

Kristina Kjærheim:

ORCID: http://orcid.org/0000-0003-0691-3735

Kristina.Kjaerheim@kreftregisteret.no

Journal

Journal ID (nlm-ta): BMC Cancer

Journal ID (iso-abbrev): BMC Cancer

Title: BMC Cancer

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2407

Publication date (Electronic): 11 October 2019

Publication date PMC-release: 11 October 2019

Publication date Collection: 2019

Volume: 19

Electronic Location Identifier: 940

Affiliations

[1 ]ISNI 0000 0004 1937 0722, GRID grid.11899.38, Department of Epidemiology, , School of Public Health, University of São Paulo, ; Av. Dr. Arnaldo 715, Pacaembu, Sao Paulo, SP CEP: 01246-904 Brazil

[2 ]ISNI 0000000405980095, GRID grid.17703.32, International Agency for Research on Cancer (IARC), WHO, ; Lyon, France

[3 ]ISNI 0000 0001 0727 140X, GRID grid.418941.1, Cancer Registry of Norway, ; Oslo, Norway

Author information

Alessandro Bigoni http://orcid.org/0000-0002-2483-3299

José Leopoldo Ferreira Antunes http://orcid.org/0000-0003-3972-9723

Elisabete Weiderpass http://orcid.org/0000-0003-2237-0128

Kristina Kjærheim http://orcid.org/0000-0003-0691-3735

Article

Publisher ID: 6184

DOI: 10.1186/s12885-019-6184-1

PMC ID: 6788078

PubMed ID: 31604464

SO-VID: d6bbe867-60b1-484f-9f38-b5a6ff2f353e

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 19 February 2019

Date accepted : 20 September 2019

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100002322, Coordenação de Aperfeiçoamento de Pessoal de Nível Superior;

Award ID: 88881.187577

Award Recipient : Alessandro Bigoni

Custom metadata

ScienceOpen disciplines: Oncology & Radiotherapy

Keywords: cancer,mortality,health services,time-series,brazil

Data availability:

ScienceOpen disciplines: Oncology & Radiotherapy

Keywords: cancer, mortality, health services, time-series, brazil

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Describing mortality trends for major cancer sites in 133 intermediate regions of Brazil and an ecological study of its causes

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Karger: Oncology

Most cited references 42

Uso da análise de séries temporais em estudos epidemiológicos

40-year trends in an index of survival for all cancers combined and survival adjusted for age and sex for each cancer in England and Wales, 1971-2011: a population-based study.

"Fundamental causes" of social inequalities in mortality: a test of the theory.

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