Socioeconomic differentials and mortality from colorectal cancer in large cities in Brazil

Abstract

The objective of this study was to compare the mortality pattern of colorectal cancer according to the social development profile of the large Brazilian cities. This was an ecological study that used as units of analysis Brazilian municipalities that were considered to be large (i.e. over 100,000 inhabitants). The social indicators adopted were obtained from the Atlas of Human Development in Brazil. Mortality data came from the Mortality Information System (MIS), represented by codes C18, C19, and C20. For data analysis, municipalities were characterised according to the indicator profile used by multivariate classification cluster analysis. It was observed that the Southeast, South, and Midwest regions concentrated over 90% of cities in the group of more developed municipalities, while the North and Northeast regions were represented by 60% of cities in the group of less developed municipalities. The mortality pattern of colorectal cancer in both groups was different, with a higher average mortality rate from colorectal cancer for populations living in cities from the more developed group (p = 0.02). The mortality rate from this cancer was shown to be directly proportional to the Municipal Human Developlemnt Index (MHDI) and inversely proportional to the inequality indicator (p < 0.001); therefore the highest means were observed among the municipalities with better socioeconomic conditions. It is important to consider social disparities to ensure equity in healthcare policy management.

Factors associated with the survival of colorectal cancer in Mexico

“…In agreement, other studies conducted in populations of low socioeconomic status or located in remote areas showed a high incidence of advanced stage disease, revealing the lack of early detection programs and, in some contexts, poorer standards of care and difficulty in accessing screening tests. 1,9,23,26 In addition, the same effect observed in our results of advanced stage disease: a very low survival of 22%, unlike the rate of survival in the early stages (68%), similarity with what has been reported for this type of cancer. 27,28 These data indicate CRC diagnosis at late stage, reducing the probability of survival, which suggests the need to increase efforts for detection in early stages.…”

“…This is the case in Mexico and specifically for the cohort under study with a high degree of marginalization. In agreement, other studies conducted in populations of low socioeconomic status or located in remote areas showed a high incidence of advanced stage disease, revealing the lack of early detection programs and, in some contexts, poorer standards of care and difficulty in accessing screening tests [ 1 , 9 , 23 , 26 ].…”

“…19,20 Similarly, these inconsistencies in survival attributed to the inequalities in socioeconomic status and the geographic area of origin. 9 Even the low level of schooling related to an increased risk of CRC. 21 A low 37% survival in the population was associated with a low level of education, which, in the multivariate analysis, was a poor prognostic factor (HR, 7.46; 95% CI, 1.02-54.7) in our cohort study.…”

“…Similarly, these inconsistencies in survival attributed to the inequalities in socioeconomic status and the geographic area of origin [ 9 ]. Even the low level of schooling related to an increased risk of CRC [ 21 ].…”

“…Similarly, lifestyle behaviors in rural area are considered risk factors for this type of cancer [ 8 ]. Some countries, such as Brazil, have reported an increase in the incidence of CRC in areas of unequal social stratum and low levels of schooling [ 9 ].…”