The impact of social inequalities on cancer incidence and mortality in a Brazilian City: Data from the population-based cancer registry.
Cancer represents one of the leading global public health challenges, with its burden shaped not only by biological factors but also by social and economic inequalities. In Brazil, even municipalities with a very high Human Development Index (HDI) exhibit persistent disparities. This study assessed temporal changes in cancer incidence, mortality, and social inequalities in Campinas, São Paulo State, Brazil.
A repeated cross-sectional study was conducted using incidence and mortality rates of the most frequent neoplasms among men and women residing in Campinas, SP, Brazil from 2010 to 2014 and 2015-2019 from the Population-Based Cancer Registry and the Mortality Information System. Age-standardized incidence and mortality rates were estimated for the most common cancers, stratified by levels of social vulnerability based on the São Paulo Social Vulnerability Index. Inequalities were analyzed using the Relative Index of Inequality (RII).
Among men, prostate cancer (RR= 0.94; 95% CI: 0.89-0.99) and stomach cancer (RR= 0.82; 95% CI: 0.72-0.93) incidence declined, while mortality remained stable for most cancers, except for an increase in colorectal cancer mortality (RR 1.15; 95% CI: 1.00-1.32 - p = 0.032 and a reduction in stomach cancer mortality (RR= 0.83; 95% CI: 0.66-1.04). Socially vulnerable men showed persistently higher mortality from prostate, stomach, and oral cavity cancers. Among women, breast cancer incidence increased (RR= 1.14; 95% CI: 1.08-1.20), and overall mortality rose (RR= 1.06; 95% CI: 1.01-1.12), particularly from lung cancer (RR= 1.25; 95% CI: 1.07-1.47). Vulnerable women exhibited consistently higher cervix uteri cancer incidence (2010-2014: RII= 2.90; 95% CI: 1.90-4.43 vs. 2015-2019: RII= 2.36; 95% CI: 1.58-3.53) and mortality (2010-2014: RII= 2.74; 95% CI: 1.42-5.26 vs. 2015-2019: RII= 3.60; 95% CI: 1.89-6.85), while breast cancer incidence remained higher among less vulnerable women (2010-2014: RII= 0.42; 95% CI: 0.37-0.49 vs. 2015-2019: RII= 0.49; 95% CI: 0.43-0.56). Inequalities in colorectal cancer incidence narrowed over time for both sexes; however, mortality inequality among men reversed, becoming higher among the most vulnerable in 2015-2019 (RII= 0.92; 95% CI: 0.66-1.29).
Despite high socioeconomic development, substantial social inequalities in cancer incidence and mortality persist in Campinas, with some disparities widening over time. These findings highlight the need for targeted and equity-oriented cancer control strategies to improve access to early diagnosis, treatment, and care among socially vulnerable populations.
A repeated cross-sectional study was conducted using incidence and mortality rates of the most frequent neoplasms among men and women residing in Campinas, SP, Brazil from 2010 to 2014 and 2015-2019 from the Population-Based Cancer Registry and the Mortality Information System. Age-standardized incidence and mortality rates were estimated for the most common cancers, stratified by levels of social vulnerability based on the São Paulo Social Vulnerability Index. Inequalities were analyzed using the Relative Index of Inequality (RII).
Among men, prostate cancer (RR= 0.94; 95% CI: 0.89-0.99) and stomach cancer (RR= 0.82; 95% CI: 0.72-0.93) incidence declined, while mortality remained stable for most cancers, except for an increase in colorectal cancer mortality (RR 1.15; 95% CI: 1.00-1.32 - p = 0.032 and a reduction in stomach cancer mortality (RR= 0.83; 95% CI: 0.66-1.04). Socially vulnerable men showed persistently higher mortality from prostate, stomach, and oral cavity cancers. Among women, breast cancer incidence increased (RR= 1.14; 95% CI: 1.08-1.20), and overall mortality rose (RR= 1.06; 95% CI: 1.01-1.12), particularly from lung cancer (RR= 1.25; 95% CI: 1.07-1.47). Vulnerable women exhibited consistently higher cervix uteri cancer incidence (2010-2014: RII= 2.90; 95% CI: 1.90-4.43 vs. 2015-2019: RII= 2.36; 95% CI: 1.58-3.53) and mortality (2010-2014: RII= 2.74; 95% CI: 1.42-5.26 vs. 2015-2019: RII= 3.60; 95% CI: 1.89-6.85), while breast cancer incidence remained higher among less vulnerable women (2010-2014: RII= 0.42; 95% CI: 0.37-0.49 vs. 2015-2019: RII= 0.49; 95% CI: 0.43-0.56). Inequalities in colorectal cancer incidence narrowed over time for both sexes; however, mortality inequality among men reversed, becoming higher among the most vulnerable in 2015-2019 (RII= 0.92; 95% CI: 0.66-1.29).
Despite high socioeconomic development, substantial social inequalities in cancer incidence and mortality persist in Campinas, with some disparities widening over time. These findings highlight the need for targeted and equity-oriented cancer control strategies to improve access to early diagnosis, treatment, and care among socially vulnerable populations.
Authors
von Zuben von Zuben, do Carmo Ferreira do Carmo Ferreira, de Azevedo Barros de Azevedo Barros, Nativo Nativo, Correa Correa, de Souza de Souza
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