A multilevel assessment of the social determinants associated with the late stage diagnosis of breast cancer

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作者
Nayara Priscila Dantas de Oliveira
Marianna de Camargo Cancela
Luís Felipe Leite Martins
Dyego Leandro Bezerra de Souza
机构
[1] Federal University of Rio Grande do Norte–UFRN,Postgraduate Programme in Collective Health
[2] Brazilian National Institute Cancer (INCA),Division of Surveillance and Analysis, Coordination of Prevention and Vigilance (CONPREV)
[3] Ministry of Health,Division of Populational Research, Coordination of Prevention and Vigilance (CONPREV)
[4] Brazilian National Institute Cancer (INCA),Department of Collective Health, Postgraduate Programme in Collective Health
[5] Ministry of Health,Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O)
[6] Federal University of Rio Grande do Norte–UFRN,undefined
[7] Faculty of Health Science and Welfare,undefined
[8] Centre for Health and Social Care Research (CESS),undefined
[9] University of Vic-Central University of Catalonia (UVic-UCC),undefined
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Scientific Reports | / 11卷
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摘要
The advanced-stage diagnosis of breast cancer reveals the inequalities associated with socioeconomic conditions and the offer of health services. This study analyzes the prevalence of advanced breast cancer and its relationship with individual and contextual socioeconomic indicators and offer of health service. A cross-sectional study is presented herein, on the assessment of malignant breast neoplasms in women diagnosed between 2006 and 2015 (n = 195,201). Data were collected from the Hospital Cancer Registry (HCR), Atlas of Human Development in Brazil, and from the National Registry of Health Institutions (NRHI). A multilevel Poisson Regression was carried out with random intercept. The prevalence of advanced breast cancer diagnosis was 40.0%. Advanced staging was associated with younger age groups (PR 1.41), race/nonwhite (PR 1.13), lower education levels (PR 1.38), and public access to health services (PR 1.25). There was also an association with a low density of mammographic equipment (PR 1.08), and with low indices of local social inequality (PR 1.33) and human development (PR 0.80). This study maps and highlights the causes related to inequalities in the diagnosis of advanced breast cancer in Brazil, and presents essential data to reorient public policies and health-related actions to strengthen the control of breast cancer in Brazil.
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