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

Abstract

Background: Oral cancer still representing one of the most frequent neoplasms worldwide, especially in developing countries. Socioeconomic factors and access to health services may be associated with the risk of oral cancer. This study analyzed the frequency of new hospitalized cases of oral cancer in Brazil, according to socioeconomic variables and data on oral health coverage in its public health system. Methods: Observational study, with a retrospective cohort design, whose sampling units was composed of all Brazilian cities that registered at least one hospitalized case of oral cancer in the National Cancer Institute database, between 2002-2017. For each city included, were collected the population size, Municipal Human Development Index (M-HDI), Gini Coefficient, as well as data regarding oral health coverage in primary care and the number of Dental Specialized Center (DSC). The COX regression was used to determine the risk ratio for a city to present a new hospitalized case of oral cancer, and the effect of the predictor variables on the incidence of cases was verified by the Hazard Ratio measure. Accumulated risk curves were obtained for the adjusted model, and for each variable. Results: All predictor variables were considered significant in the regression model (p<0.05). Cities above 50 thousand inhabitants, with high or very high M-HDI, more unequal (Gini>0.4), with less oral health coverage in primary care (<50%) and without the presence of DSC demonstrated a greater accumulated risk of having 1 or more hospitalized cases of oral cancer. Conclusions: The risk of hospitalization for oral cancer in Brazil is greater in cities with a larger population size, more developed, with greater inequality of income distribution and with less availability of public oral health services.