Trend of hospitalized cases of oral cancer in Brazil and its relationship with oral health coverage in public health system between 2009 and 2017

Abstract

Background This study aimed to analyze the trend in the number of hospitalized cases of oral cancer in Brazil, according to the coverage of oral health services in public health system, and also investigate the influence of healthcare and clinical characteristics on the severity of oral cancer cases. Material and Methods This retrospective study considered the period between 2009 and 2017. Data from the Hospital Registry of Cancer from the National Cancer Institute were used, considering the primary locations C00 to C06. Detailed information including sex, age, alcohol and tobacco use, year of first consultation, and the clinical stage of the cases were also collected. The frequency of hospitalized cases was correlated with the coverage of Primary Care Oral Health Teams (ESB) and the number of Dental Specialty Centers (CEO). It was also estimated the chance of advanced oral cancer cases, according to healthcare and clinical characteristics. Data were analyzed using Tweedie's multiple regression and multiple binary logistic regression (α<0.05). Results There was an increasing trend in the number of hospitalized cases of oral cancer in Brazil between 2009 and 2017 (B=0.043, p<0.001, PR=1.044). The increase in ESB coverage was associated with small increase in the number of hospitalized cases of oral cancer (B=0.001, p =0.003, PR=1.001). The increase in the number of CEO was associated with decrease in the number of hospitalized cases of oral cancer (B=-0.085, p <0.001, PR =0.918). The increase of ESB (OR=0.998) and CEO (OR=0.974) contributed for reducing the number of stage IV cases, whilst the history of alcohol and tobacco use (OR=1.574) was associated with an increase in the number of stage IV cases. Conclusions Although an increasing trend was detected, the expansion of the public health system reduced the number of hospitalized cases and the frequency of advanced oral cancer cases in Brazil. Key words: Mouth neoplasms, squamous cell carcinoma, oral diagnosis.

Influence of Public Oral Health Services and Socioeconomic Indicators on the Frequency of Hospitalization and Deaths due to Oral Cancer in Brazil, between 2002–2017

“…Nevertheless, results of the present study also demonstrated that cities with higher oral health coverage in primary care had lower number of hospitalization and lower number of deaths due to oral cancer. This corroborates a previous study from our research group, which highlighted the contribution of Brazilian National Oral Health Policy in reducing the frequency of hospitalization due to oral cancer [ 16 ]. In addition, investing in public oral health services may be an alternative to reduce social inequalities in health, and then also provide dignity and access to oral cancer prevention and treatment.…”

“…In addition, the population of those cities has higher life expectancy, which increases the proportion of the risk group for advanced age, in addition to greater access to diagnosis and hospitalization [ 19 , 20 ]. Also, it was expected that larger cities, with larger population, presented major number of cases [ 16 ]. Inverse associations between MHDI and oral cancer were found in studies that evaluated mortality rates [ 9 , 10 , 20 ].…”

“…This analysis revealed that cities with strong inequality in the income distribution have a higher risk of presenting hospitalized cases of oral cancer. Socioeconomically disadvantaged individuals are often diagnosed with lesions in advanced clinical stages and with cervical metastases, which require complex treatments performed in the hospital setting [ 8 , 16 ]. Previous studies that used regions and states as sample units found no association between the Gini coefficient and oral cancer rates [ 13 , 17 ].…”

“…Nonetheless individual factors such as sex, age, alcohol and tobacco consumption are remarkably associated to the incidence of oral cancer [ 7 , 8 , 9 , 10 ], other environmental socioeconomic variables should be investigated with regards their role on oral cancer incidence. Recent investigations from our research group have demonstrated the impact of socioeconomic factors and public oral health services on the rate of oral cancer hospitalization in Brazil [ 15 , 16 ]. Higher inequality rates, lower sanitation levels and poor education are associated with higher hospitalization rates [ 15 ].…”

“…Higher inequality rates, lower sanitation levels and poor education are associated with higher hospitalization rates [ 15 ]. In addition, higher availability of public oral health services contributed to lower oral cancer hospitalization rates and lower frequency of stage IV lesions [ 16 ].…”