Nível socioeconômico e sobrevida líquida de pacientes com câncer no Brasil: análise de dados populacionais dos municípios de Aracaju (SE) e Curitiba (PR), 1996 a 2012

Abstract

Cancer incidence is increasing worldwide, and the disease is related to significant morbidity and mortality. Several international studies have pointed out the existence of inequities related to the prognosis of the disease in terms of socioeconomic conditions and ethno-racial characteristics. The present study aims to analyze the impact of social and economic aspects on cancer net survival including patients diagnosed with malignant neoplasms of breast, lung, prostate, cervix uteri and colorectal tumors, in the municipalities of Aracaju (SE) and Curitiba (PR), among the years 1996 and 2012. A retrospective cohort was compiled with data from Population-based Cancer Registries. Stratification by socioeconomic level was performed through the construction of a contextual indicator based on information on income and education, attributed to individuals according to region of residence. Flexible multilevel models were built to analyze the excess mortality hazard related to the diagnosis of cancer according to socioeconomic level, race-color, age and year of diagnosis, for each sex tumor site couple. The mortality hazard ratios and the age adjusted net survival percentages of 2, 5 and 8 years from the date of diagnosis were estimated. Information on a total of 28,005 cancer cases in the two municipalities was analyzed. During the study period, there was an increase in net survival percentages for all types of cancer, even for the most aggressive tumors. Patients residing in Curitiba had higher survival rates compared to patients from Aracaju, even after stratification by socioeconomic level. Differences in terms of socioeconomic level were found for the populations of both municipalities, showing greater magnitude in Curitiba. There was no reduction of these differences over the study period. The results of the present study indicate an increase in socioeconomic, ethno-racial and regional inequalities in cancer survival for patients in these two Brazilian cities during the past three decades. These findings highlight the importance of strengthening cancer care policies with focus on reducing inequalities in access to diagnostic and therapeutic services