Characteristics and in-hospital morbidity trends associated with oral and oropharyngeal cancers in Brazil

Abstract

Background Brazil experienced an expansion of the population's access to oral health policies after the creation of the Unified Health System (SUS, Sistema Único de Saúde). Through public policies, the consolidation of Primary Health Care (PHC) and the incorporation of dental care into primary and hospital care took place. The objective of this study was to identify epidemiological aspects, including the temporal trend, of hospital morbidity from oral and oropharyngeal cancer in Brazil, considering hospitalizations for this neoplasm in a hospital network linked to the public care system. Methods Observational study based on information on hospital admissions for oral cancer throughout Brazil. The research used data from the Brazilian Cancer Registry Information System. For the temporal series analysis, generalized linear regression model was used with the Prais-Winsten method. Results Of the 121,971 patients hospitalized with oral and oropharyngeal cancers, 76.40% were male and 23.60% were female, resulting in a M:F ratio of 3.24:1. Regarding the anatomical region of involvement among hospitalized patients with oral cavity neoplastic lesions, there was a predominance in non-specific places in the mouth, such as the floor of the mouth, soft and hard palate, among others (32.68%), followed by lesions in the region of tongue (28.89%). In this population, the predominant age group was between the fifth decade (31.09%) and sixth decade of life (24.99%); men presented neoplastic lesions of oral and oropharyngeal cancers at an earlier age than women. In all regions of the country, the staging of cases diagnosed in the tertiary health network accredited to the José Alencar Gomes da Silva National Cancer Institute (INCA) was late, with higher tendency for metastasis. The temporal trend of the adjusted in-hospital morbidity rates showed to be increasing in the Northeast, South and Midwest regions for the male gender. For females, they were increasing in the Northeast and South regions. Conclusions It is concluded that the distribution of in-hospital morbidity rates of oral and oropharyngeal cancers in the country is irregular. There is a greater number of cases identified by the study in male patients and in the Southeast and South regions; with an increasing tendency of this coefficient in both genders.

Contribution of public oral pathology services to the diagnosis of oral and oropharyngeal cancer in Brazil

“…Notwithstanding the epidemiologic changes observed in the past decades, during which the incidence of HPV-related OPSCC has increased in several countries, 2 tobacco and alcohol consumption remain the most frequent risk factors in the development of OPSCC in the Brazilian population, corresponding to 83.8% and 63.3% of our sample, respectively. These results are compatible with data from the INCA database 21,22 and other low-and middle-income countries from Asia 25 and South America. 24 Therefore, the epidemiologic transition of oropharyngeal carcinogenesis may not have manifested itself among Brazilian patients.…”

“…Conversely, most OPSCC patients are non-Caucasian males, with an average age of 58.7 years at the time of diagnosis. 14,21 Historically, LSCC, OSCC and OPSCC have been linked to socioeconomic status in low-and middle-income countries, with the highest prevalence rates occurring in the most disadvantaged population groups. 15,[22][23][24] Accordingly, 71.8% of all patients in the current study had only up to 8 years of formal education, especially OPSCC individuals.…”

“…15 Similarly, the INCA database collects cancer data from the population-based and hospital-based cancer registries of the five Brazilian geographic regions, but, just like the FOSP, only keeps records of whether the patient arrived at the hospital with or without a previous diagnosis. 21,22 Therefore, this lack of information on the laboratory responsible for the diagnosis means that the significant contribution made by public university OMPLs with respect to cancer diagnosis in the SUS remains unknown to society and the government.…”

Caries-related hospital morbidity in the Brazilian Unified Health System from 2008 to 2022

“…Data collection was based on the considerations of Bittencourt et al (2006) 28 regarding the applicability of SIH/SUS in epidemiological studies in public health, as well as on the procedure carried out by a similar study. 30 The data was collected by a single researcher in April 2023. Caries-related AIH were screened using the filters available in SIH/SUS to stratify according to the list of morbidities of the International Statistical Classification of Diseases and Related Health Problems -10th revision, (ICD-10), reviewed by the World Health Organization.…”