Cancer Epidemiol. 2021 Feb 4;71(Pt A):101899. doi: 10.1016/j.canep.2021.101899. Online ahead of print.
BACKGROUND: Cervical cancer survival is marked by socioeconomic and demographic inequalities. We investigated differences in survival across health regions in Minas Gerais, Brazil, in cervical cancer patients who underwent treatment in the Brazilian Public Health System.
METHODS: From a database developed through probabilistic and deterministic linkage of data from information systems of the Brazilian Public Health System, we identified cervical cancer cases, diagnosed between 2002 and 2010, who underwent radiation and/or chemotherapy and lived in Minas Gerais, Brazil. Five-year overall and cause-specific survivals were estimated by the Kaplan-Meier method and compared using the log-rank test. We used extended Cox models to assess the relationship between the health region of residence and the overall and cause-specific death risk, adjusting for relevant variables.
RESULTS: We included 5613 patients with a median age of 55.0 years. Median follow-up time was 70.0 months. Five-year overall and cause-specific survivals were 56.3 % and 63.6 %, respectively. Across the 13 health regions, 5-year survival ranged from 46.6%-64.2% (p < 0.001) in the overall analysis and from 52.0% to 72.0% (p < 0.001) in the cause-specific analysis. Multivariate models revealed a significantly higher death risk for most health regions in comparison to the reference health region (Norte). Adjustment by age, tumor stage, comorbidity, treatment, travel time, and year of diagnosis had little effect on the association.
CONCLUSION: We found regional disparities in cervical cancer survival that persisted after relevant adjustments. Uneven regional provision of health services might be implicated in these disparities, affecting timely access to treatment for cervical cancer patients.