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. 2023 May 25;22(1):102.
doi: 10.1186/s12939-023-01912-8.

Social determinants influencing cervical cancer diagnosis: an ecological study

Juan Fernando Galindo  1 , Giovana Moura Formigari  2 , Luiz Carlos Zeferino  2 , Carla Fabrine Carvalho  2 , Edson Luiz Ursini  1 , Diama Bhadra Vale  3
Affiliations

Social determinants influencing cervical cancer diagnosis: an ecological study

Juan Fernando Galindo et al. Int J Equity Health. .

Abstract

Background: Barriers to accessing health care result in advanced cervical cancer. In Sao Paulo, Brazil, the Index of Social Responsibility (ISR) synthesizes the situation of each town concerning wealth, education, and longevity. This study aimed to evaluate in 645 municipalities the relation of the ISR with stage, age, and morphology in cervical cancer diagnosis.

Methods: An ecological study that used data from Sao Paulo, Brazil, from 2010 to 2017. The ISR was identified through government platforms and data on cancer through the Hospital Cancer Registry. The subjects were the 9,095 women aged 30 years or older. The ISR summarizes municipalities into five levels: dynamic (ISR5), unequal (ISR4), equitable (ISR3), in transition (ISR2), and vulnerable (ISR1). It was used the chi2 tests and logistic regression.

Results: The proportion of stage 1 increased significantly with ISR level, ranging from 24.9% in ISR1 to 30.0% in ISR5 (p = 0.040). To every increase in ISR level, the chance of a woman being diagnosed in stage I was at least 30% higher. Woman living where ISR2 had a 1.4 times higher chance of being diagnosed in stage 1 than those living in ISR1 (OR 1.40, 95% CI 1.07-1.84). Squamous tumors frequency decreased when ISR level increased (p = 0.117). A higher proportion of women under 50 years were observed when they lived in wealthier cities (ISR4 and ISR5) (42.2% vs. 44.6%, p = 0.016).

Conclusion: The ISR was a good health indicator for understanding and predicting the social determinants in cervical cancer diagnosis. The proportion of stage I increased significantly in more favorable social conditions.

Keywords: Health Equity; Social Determinants of Health; Social Vulnerability; Uterine Cervical Neoplasms.

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Conflict of interest statement

None to declare.

Figures

Fig. 1
Fig. 1
Distribution of 9,095 cases of cervical cancer according to the Index of Social Responsibility of the State of Sao Paulo, Brazil, from 2010 to 2017
See this image and copyright information in PMC

References

    1. Bray F, Jemal A, Grey N, Ferlay J, Forman D. Global cancer transitions according to the Human Development Index (2008–2030): a population-based study. Lancet Oncol. 2012;13(8):790–801. doi: 10.1016/S1470-2045(12)70211-5. - DOI - PubMed
    1. Vale DB, Teixeira JC, Bragança JF, Derchain S, Sarian LO, Zeferino LC. Elimination of cervical cancer in low- and middle-income countries: inequality of access and fragile healthcare systems. Int J Gynaecol Obstet. 31 de outubro de 2020;. - PubMed
    1. World Health Organization. A Global Strategy for elimination of cervical cancer [Internet]. [citado 14 de junho de 2020]. Disponível em: https://www.who.int/activities/a-global-strategy-for-elimination-of-cerv....
    1. Vale DB, Sauvaget C, Muwonge R, Thuler LCS, Basu P, Zeferino LC et al. Level of human development is associated with cervical cancer stage at diagnosis. J Obstet Gynaecol. 19 de setembro de 2018;1–5. - PubMed
    1. World Health Organization. Social determinants of health [Internet]. [citado 23 de outubro de 2021]. Disponível em: https://www.who.int/westernpacific/health-topics/social-determinants-of-....

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