Exploring cervical cancer mortality in Brazil: an ecological study on socioeconomic and healthcare factors

Keywords

uterine cervical neoplasms - socioeconomic factors - health disparities - healthcare accessibility - Papillomavirus infections

Introduction: Cervical cancer is the fourth most common malignancy among women globally, primarily caused by human papillomavirus (HPV) infection. Despite advancements in vaccination and screening, socioeconomic disparities significantly impact cervical cancer rates, particularly in underdeveloped countries. In Brazil, marked variations in incidence and mortality highlight the influence of geographical and socio-demographic factors on healthcare access and outcomes.

Objective: To assess how socioeconomic and healthcare factors influence access to prevention and treatment services and cervical cancer mortality in Brazil.

Methods: This cross-sectional study analyzed public data on the Brazilian National Institute of Cancer (INCA), the National Institute of Geography and Statistics (IBGE), and the Brazilian Ministry of Health. Data was collected on indicators such as the Human Development Index (HDI), physician density, average household income, HPV vaccine coverage, pap smear screening rates, radiotherapy machine density, and non-white population rates by state and macroregion across Brazil. Spearman's rank correlation test and simple linear regression analysis were employed.

Results: Cervical cancer mortality rate is statistically lower in women with health insurance, positive self-perception of health, located in states with a higher HDI, per capita household income, density of physicians, and radiotherapy machines per 1,000 inhabitants. In contrast, mortality rates proportionally increase according to poverty levels, as expected, and rates of non-white population. Considering public health, HDI scores significantly affected Pap smear test coverage, the number of radiotherapy machines, and HPV vaccine uptake. The North and the Southeast regions have, respectively, the lowest and the highest socioeconomic indicators, proportional to their mortality rates. No significant correlation was found between mortality rates and HPV vaccine or pap smear coverage.

Conclusion: Cervical cancer mortality in Brazil is significantly influenced by socioeconomic and healthcare disparities. This study provides a data-driven basis for public health strategies that address both medical and social determinants of health.

Corresponding author: Eduarda Naves Gonçalves de Almeida (e-mail: [e-mail]).