Women mortality due to cancers of the breast and cervix of the uterus: temporal and spatial analysis. City of São Paulo, SP, Brazil, 1996 to 2006 / Mortalidade por câncer de mama e de colo de útero: análise temporal e espacial, município de São Paulo, 1996 a 2006

AUTOR(ES)
DATA DE PUBLICAÇÃO

2009

RESUMO

Introduction: Several studies have shown that effects of inequalities in the mortality profiles and in different social groups are associated with social, cultural and economic factors. The analysis of the mortality due to breast cancer and cervix in women living in São Paulo, by local of residence, permitted to estimate the risk of dying from these cancers in different social groups. This knowledge would provide motivation for specific actions of public services in the control of risk factors and the organization of health services. Objective: To describe patterns of mortality due to breast cancer and cancer of the cervix in women aged 15 years and over, living in São Paulo, according to geographical, temporal and socioeconomic profile variations, from 1996 to 2006. Methods: Ecological study using time of death from the Mortality Information System - SIM, which, in São Paulo is processed by the Information Program of Improvement of Mortality - PRO-AIM from the Municipal Secretariat of São Paulo. For spatial analysis, the 96 districts of the city of São Paulo were grouped into eight Regions of administrative division, adopted by the State Foundation of the System of Data Analysis and Municipal Secretary of Social Assistance and Development of São Paulo. The time series comprehends 1996 to 2006, in three sections, 1996/1997/1998, 1999/2000/2001, 2004/2005/2006. This arrangement aims to reduce possible fluctuations occurring in a given year. To ensure the comparability of mortality rates of the two anatomic locations of tumors between the regions and in time, the coefficients were adjusted by age, by the direct method, considering as the standard population, persons living in São Paulo in 2000. For the analysis of socioeconomic conditions was used as a "proxy", the Index of Inclusion/Exclusion (IEX), for the possibilities of access and use of public health services. To evaluate the spatial dependence between variables were used indices of Global and Local Moran. Thematic maps were assembled (coropletic), through the software TerraView Philcarto version 3.3.0 and 5.0. Results: Although mortality rates for breast cancer and the cervix have remained almost stationary for the city of São Paulo, looking the adjusted rates, it was detected that levels were always higher than the state, even in regions with lower risk of both cancers. The spatial analysis showed a concordance between the most central regions (with highest values of IEX) and areas with the greatest risks for breast cancer. Similarly, there was a coincidence between the more periferical regions and the areas with the lowest rates of IEX, identified as areas of greatest risk for cancer of the cervix. Conclusion: Taking into account the limitations of this study, we can conclude that the pattern of mortality from breast cancer and cervix uteri, in São Paulo, shows the existence of health problems in both regions, with a low IEX (greater resources and availability of health equipment) or an high IEX (there is a need for improvements in screening programs and provision of specialist services). The knowledge of these associations may help the implementation of health care policies for women, promoting measures for sectional interventions targeting to each population group.

ASSUNTO(S)

cancer of the cervix social inequality breast cancer câncer de mama câncer de colo do Útero mortalidade desigualdade social mortality

ACESSO AO ARTIGO

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