Spatial distribution of breast cancer mortality: Socioeconomic disparities and access to treatment in the state of Parana, Brazil

Abstract

IntroductionBreast cancer remains an important public health problem that is responsible for high morbidity and mortality rates, especially in developing countries.ObjectiveTo analyze the socioeconomic and access disparities related to breast cancer mortality in 399 cities in the state of Parana, Brazil.MethodsEcological, descriptive and analytical cross-sectional study based on secondary data from the Mortality Information System from 2009 to 2012 in the state of Parana. Breast cancer mortality rate was calculated considering the mortality cases and women population of each municipality, both based on women older than 20 years old. Moran global and local analyses were used to verify the presence of spatial autocorrelation and spatial regression modeling (Spatial Lag—SAR) with the purpose of analyzing the association between socioeconomic indicators, access and mortality rates for breast cancer.ResultsSignificant positive spatial autocorrelation was found for breast cancer mortality rates (I = 0.5432, p = 0.001). In the spatial regression analysis, the model explained 61% of the variance of the mortality rates for breast cancer. The mortality rate for breast cancer was negatively associated with the illiteracy rate (Coefficient = -0.0279) and positively associated with the access index (Coefficient = 12.9525).ConclusionThe lower illiteracy rate has not been sufficient to reduce the specific mortality rate by breast cancer, and the higher the score of accessibility to cancer services, the higher the specific mortality due to breast cancer. The results show that in the state of Parana, the problem is not related to a lack of education of the patients or the distance walked, but rather with the organization of services. These conclusions have important political implications on the organization and quality of the services provided for the diagnosis and treatment of breast cancer in the state of Parana.

A multilevel assessment of the social determinants associated with the late stage diagnosis of breast cancer

“…The North and Northeast regions present irregular population occupations, which limits the distribution of health services in the territory. The Northeast region, in turn, concentrates technologies and health services in large urban centers, which limits the offer of intermediate-level healthcare 26 , 27 .…”

Spatial distribution of advanced stage diagnosis and mortality of breast cancer: Socioeconomic and health service offer inequalities in Brazil

“…The North and Northeast regions show irregular population distribution, with large areas presenting low population density, limiting the distribution of health services in the territory. Despite depicting a well-defined territorial occupation, the Northeast concentrates health services and technology in large urban centers the occupy the coastal region, which limits the offer of healthcare and technology to the population of the interior [ 7 , 36 ].…”

“…The sociopolitical and economic contexts associated with the access to healthcare are considered the main factors contributing to inequalities in morbimortality for breast cancer [ 7 ]. In Brazil, the vast extension of the territory and its historical and unequal spatial distribution of municipalities and population have contributed significantly to the contrasts in income distribution in the country [ 40 ].…”

“…Health-related inequalities related to the diagnosis and mortality of breast cancer are affected by contextual socioeconomic conditions and the offer and access to health services [ 7 ]. In Brazil, there are high social and income-related inequalities [ 5 , 8 ].…”

“…The significant territorial extension and accentuated regional socioeconomic diversity contribute to the irregular distribution of health services and technologies in the Brazilian geographic space. There is limited offer and access to healthcare directed to early detection and timely treatment of breast cancer, incapable of meeting the necessities of the population [ 7 ].…”