Mortality from oral and oropharyngeal cancer in Brazil: impact of the National Oral Health Policy

Abstract

The objective was to investigate if there is an association between the mortality rates due to oral and oropharyngeal cancer in Brazil and the expansion of access to public primary and specialized dental care services that resulted from the implementation of the National Oral Health Policy, between 2000 and 2013. The mortality data were obtained from the records of the Mortality Information System and the exposure variables were obtained from databases of the Brazilian Ministry of Health and the Brazilian Institute of Geography and Statistics. The main exposures investigated were “coverage of primary dental care” and “number of specialized dental care centers”. Additional covariates included “Gini index of household income”, “average number of years of study”, “proportion of unemployed people” and “proportion of smokers”. For the statistical analysis, a random coefficient model was used. There was a statistically significant association between the mortality rates by oral and oropharyngeal cancer with coverage by primary dental care and the number of specialized dental care centers with males. This study found that the expansion of the coverage of primary dental care and the number of specialized dental care centers are associated with the reduction of mortality rates due to oral and oropharyngeal cancer in Brazil. There is plausibility for the association found, which needs to be confirmed by implementation studies.

Public Oral Health Services Coverage and Socioeconomic Indicators’ Effect on The Number of Hospitalized Cases of Oral Cancer in Brazil

“…The lower coverage of oral health in primary care and the absence of DSC are related to the higher risk of hospitalization for oral cancer, according to the ndings of this investigation. Studies have also found similar impacts of these variables on oral cancer mortality rates in Brazil in recent decades 13,15 . The lack of access to health services is one of the main factors related to the delay in the diagnosis of oral cancer, which often results in the need for more aggressive and mutilating treatments, reducing the individual's survival 25 .…”

“…Socioeconomically disadvantaged individuals are often diagnosed with lesions in advanced clinical stages and with cervical metastases, which require complex treatments performed in the hospital setting 8 . Previous studies that used regions and states as sample units found no association between the Gini coe cient and oral cancer rates 13,15 . However, other studies with more speci c and similar populations, considering cities and neighborhoods, were able to detect a positive association between income inequality and oral cancer, like the present study 20,21 .…”

“…Taking this into account, the expansion of oral health coverage in primary and specialized care, especially in the sense of equity, prioritizing populations in socioeconomic vulnerability, are essential strategies for improving the epidemiological scenario of oral cancer in Brazil 13,24 . In this sense, some urgent measures are highlighted, such as the increase in government investments in health, the implementation of public policies to combat social inequalities, the control of behavioral risk factors for oral cancer, the training of oral health professionals in the early identi cation of precancerous lesions and the expansion of health education measures for the general population.…”

“…This policy provided an increase in access to oral health in primary care, in addition to implementing specialized dental care services throughout the country, through the creation of the Dental Specialized Center (DSC) 12 . NOHP prioritized oral cancer care at different levels of care, fostering prevention actions, active screening, and early diagnosis 12,13 .…”

Mortality- and Health-Related Factors in a Community-Dwelling of Oldest-Older Adults at the Age of 90: A 10-Year Follow-Up Study

“…Studies have found that specific health-related factors are regarded as risks after adjustment for common risk factors. An investigation was performed within specific health-related factors, including nutrition [28,29], oral health [30][31][32][33][34][35][36][37][38], and physical performance [39][40][41][42][43][44][45]. In addition to this risk evaluation, a comprehensive assessment for the risk factors for mortality is necessary for planning health promotion for older adults [46,47], decision of priority of intervention [48][49][50], and health-related political decision-making.…”