Describing mortality trends for major cancer sites in 133 intermediate regions of Brazil and an ecological study of its causes

Abstract

Background In Brazil, 211 thousand (16.14%) of all death certificates in 2016 identified cancer as the underlying cause of death, and it is expected that around 320 thousand will receive a cancer diagnosis in 2019. We aimed to describe trends of cancer mortality from 1996 to 2016, in 133 intermediate regions of Brazil, and to discuss macro-regional differences of trends by human development and healthcare provision. Methods This ecological study assessed georeferenced official data on population and mortality, health spending, and healthcare provision from Brazilian governmental agencies. The regional office of the United Nations Development Program provided data on the Human Development Index in Brazil. Deaths by misclassified or unspecified causes (garbage codes) were redistributed proportionally to known causes. Age-standardized mortality rates used the world population as reference. Prais-Winsten autoregression allowed calculating trends for each region, sex and cancer type. Results Trends were predominantly on the increase in the North and Northeast, whereas they were mainly decreasing or stationary in the South, Southeast, and Center-West. Also, the variation of trends within intermediate regions was more pronounced in the North and Northeast. Intermediate regions with higher human development, government health spending, and hospital beds had more favorable trends for all cancers and many specific cancer types. Conclusions Patterns of cancer trends in the country reflect differences in human development and the provision of health resources across the regions. Increasing trends of cancer mortality in low-income Brazilian regions can overburden their already fragile health infrastructure. Improving the healthcare provision and reducing socioeconomic disparities can prevent increasing trends of mortality by all cancers and specific cancer types in Brazilian more impoverished regions.

Mortalidade por câncer nas capitais e no interior do Brasil: uma análise de quatro décadas

“…Some previous studies 6 , 38 , 39 follow the methodology proposed by the study Global Burden of Disease (GBD) 40 , which redistributes recorded deaths among causes considered as garbage codes. In this set of codes, in addition to the deaths recorded in chapters 16 of ICD-9 and 18 of ICD-10, other ill-defined causes and incomplete diagnoses from other chapters are included.…”

“…Previous studies that showed the trend of cancer in Brazil, with methodology applying correction of death data, included shorter periods than presented here: 1980-2006 5 , 1990-2015 6 and 1996-2016 39 . In the case of cancer, it is important to understand the evolution of incidence and mortality for a longer period, as it was possible to show with data from SIM since 1978.…”

“…Alguns estudos prévios 6 , 38 , 39 seguem a metodologia proposta pelo estudo Carga Global de Doença (Global Burden of Disease – GBD) 40 , que redistribui os óbitos registrados entre causas consideradas como códigos garbage . Nesse conjunto de códigos, são incluídos, além dos óbitos registrados nos capítulos XVI da CID-9 e XVIII da CID-10, outras causas maldefinidas e diagnósticos incompletos vindos de outros capítulos.…”

Susceptibility Loci for Pancreatic Cancer in the Brazilian Population

“…A major cause for the poor prognosis is the late diagnosis and the resistance to conventional treatment [3] and, differently from other tumor types, mortality rates for PA are not improving [4,5]. In Brazil, PA was responsible for more than 11,000 deaths in 2018, and PA incidence and lethality are increasing in the country [6,7].…”

“…Somatic mutation in pancreatic cells is an essential carcinogenesis event and strongly related with genes such as KRAS, CDKN2A, TP53, SMAD4. KRAS missense mutations include mainly three hot spots: glycine-12 (G12), glycine-12 (G13), or glutamine-61 (Q61), and occurs virtually in all PA cases [7][8][9] .…”