Indicators of social inequalities associated with cancer mortality in Brazilian adults: scoping review

Costa, Ana Cristina de Oliveira; Ramos, Dandara de Oliveira; Sousa, Romulo Paes de

doi:10.1590/1413-81232024298.19602022EN

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

ARTICLES REVIEWS • Ciênc. saúde coletiva 29 (08) • Aug 2024 • https://doi.org/10.1590/1413-81232024298.19602022EN copy

Indicators of social inequalities associated with cancer mortality in Brazilian adults: scoping review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The objective of this study was to identify indicators of social inequalities associated with mortality from neoplasms in the Brazilian adult population. A scoping review method was used, establishing the guiding question: What is the effect of social inequalities on mortality from neoplasms in the Brazilian adult population? A total of 567 papers were identified, 22 of which were considered eligible. A variety of indicators were identified, such as the Human Development Index and the Gini Index, which primarily assessed differences in income, schooling, human development and vulnerability. A single pattern of association between the indicators and the different neoplasms was not established, nor was a single indicator capable of explaining the effect of social inequality at all levels of territorial area and by deaths from all types of neoplasms identified. It is known that mortality is influenced by social inequalities and that the study of indicators provides an opportunity to define which best explains deaths. This review highlights important gaps regarding the use of non-modifiable social indicators, analysis of small geographical areas, and limited use of multidimensional indicators.

Key words:
Mortality; Neoplasms; Social differences; Health inequality; Brazil

Search strategy	Databases	References retrieved
(Neoplasias OR Neoplasms OR Tumeurs OR Câncer OR Neoplasia OR Neoplasmas OR Tumor OR Tumores OR Cancer OR Cancers OR Neoplasm OR Tumors) AND (Mortalidade OR Mortality OR Mortalidad OR Mortalité OR “Taxa de Casos Fatais” OR “Taxa de Fatalidade” OR “Taxa de Letalidade” OR “Taxa de Mortalidade” OR “Índice de Casos Fatais” OR “Índice de Fatalidade” OR “Índice de Letalidade” OR “Índice de Mortalidade” OR “Death Rate” OR “Death Rates” OR Mortalities OR “Mortality Rate” OR “Mortality Rates”) AND (“Fatores Socioeconômicos” OR “Socioeconomic Factors” OR “Factores Socioeconómicos” OR “Facteurs socioéconomiques” OR “Aspectos Socioeconômicos” OR “Desigualdade Social” OR “Desigualdades Sociais” OR “Inequidade Social” OR “Iniquidade Social” OR “Fatores Econômicos” OR “Economic Factors” OR “Factores Económicos” OR “Facteurs économiques” OR “Fatores Sociais” OR “Social Factors” OR “Factores Sociales” OR “Disparidades nos Níveis de Saúde” OR “Health Status Disparities” OR “Disparidades em el Estado de Sal”d" O“ "Disparités de’l'état de san”é" O“ "Desigualdade em Saú”e" O“ "Desigualdade na Saú”e" O“ "Desigualdades em Saú”e" O“ "Disparidades em Saú”e" O“ "Iniquidade em Saú”e" O“ "Iniquidade na Saú”e" O“ "Saúde e Desigualda”e" O“ "Social Inequaliti”s" O“ "Social Inequali”y" O“ "Social Inequi”y" O“ "Socioeconomic Fact”r" O“ "Health Status Dispari”y") AND (Brasil OR Brazil OR Brésil)	Biblioteca Virtual em Saúde	256
(Neoplasms OR Neoplasias OR Neoplasia OR Cancer OR Cancers OR Neoplasm OR Tumor OR Tumors) AND (Mortality O“ "Death Ra”e" O“ "Death Rat”s" OR Mortalities O“ "Mortality Ra”e" O“ "Mortality Rat”s") AND“("Socioeconomic Facto”s" O“ "Economic Facto”s" O“ "Social Facto”s" O“ "Health Status Dispariti”s" O“ "Social Inequali”y" O“ "Social Inequi”y" O“ "Socioeconomic Fact”r" O“ "Health Status Dispari”y") AND (Brasil OR Brazil)	MEDLINE via PubMed	139
	Web of Science	46
	Scopus	126

Author, year of publication, place and type of study	Neoplastic site (CID)	Social Inequality Indicator	Principal results
Lima et al. (2022)¹⁰10 Lima KYN, Cancela MC, Souza DLB. Spatial assessment of advanced-stage diagnosis and lung cancer mortality in Brazil. PloS One 2022; 17(3):e0265321., Brazil (RIAU), ecological study.	Lung (C33-34)	Income per capita; Aging rate; Gini Index; Degree of urbanization.	Age-adjusted lung neoplasm mortality rates were influenced by social contexts, causing high mortality clusters in the RIAU of the Centre-west and South, and low mortality in the Northern and Northeastern RIAU, i.e. high rates were verified in regions with better socioeconomic indicators, while the less developed concentrated lower rates.
Ferreira et al. (2022)²³23 Ferreira MC, Sarti FM, Barros MBA. Social inequalities in the incidence, mortality, and survival of neoplasms in women from a municipality in Southeastern Brazil. Cad Saude Publica 2022; 38(2):e00107521., Campinas Municipality, ecological study.	Breast (C50); Colorectal (C18-20); Lungs and Bronchi (C33-34), Stomach (C16); Cervix (C53); Thyroid (C73)	Social Vulnerability Index in São Paulo, 2010.	Higher mortality rates due to cervical, stomach and lung neoplasms and the lowest mortality rates by breast and colorectal neoplasms were identified among women of greater social vulnerability compared to women with less vulnerability.
Oliveira et al. (2021)³⁷37 Oliveira NPD, Cancela MC, Martins LFL, Souza DLB. Spatial distribution of advanced stage diagnosis and mortality of breast cancer: socioeconomic and health service offer inequalities in Brazil. PloS One 2021; 16(2):e0246333., Brazil (RIAU), ecological study.	Breast (C50)	Gini Index; HDI.	Adjusted mortality rates for breast neoplasia showed positive and statistically significant correlation with HDI in the southern and southeastern regions, which have generally high levels of global socioeconomic development, concentrating high mortality rates.
Duarte et al. (2020)³³33 Duarte DAP, Nogueira MC, Magalhães MC, Bustamante-Teixeira MT. Iniquidade social e câncer de mama feminino: análise da mortalidade. Cad Saude Colet 2020; 28(4):465-476., Minas Gerais State, ecological study.	Breast (C50)	Health Vulnerability Index; Regional HDI; Degree of urbanization; Income per capita.	Microregions with higher degrees of urbanization, higher income and high regional HDI are those that have the highest rates of mortality due to breast neoplasia in Minas Gerais State.
Freire et al. (2020)³⁸38 Freire AR, Freire DEWG, Araújo ECF, Lucena EHG, Cavalcanti YW. Influence of public oral health services and socioeconomic indicators on the frequency of hospitalization and deaths due to oral cancer in Brazil, between 2002-2017. Int J Environ Res Public Health 2020; 18(1):e238. Brazil (Municipalities), retrospective cohort observational study.	Oral (C00-C06)	Municipal HDI; Gini Index.	Greater Municipal HDI (≥ 0.700) and higher inequality (Gini Index> 0.4) are associated with the highest frequency of deaths.
Ramos et al. (2020)²⁷27 Ramos JLS, Figueiredo FWDS, Zuchelo LTS, Purcino FAC, Adami F, Goncalves R, Ruiz CA, Baracat EC, Soares Junior JM, Sorpreso ICE. Health services, socioeconomic indicators, and primary care coverage in mortality by lower genital tract and breast neoplasias in Brazilian women during reproductive and non-reproductive periods. Int J Environ Res Public Health 2020; 17(16):5804., Brazil (states/regions), ecological study.	Breast (C50); Inferior genital tract (C51-C57)	Gini Index; female illiteracy rate per 100,000 inhabitants; Income per capita; mean found in the population study over the years.	Reproductive period: Low income per capita is associated with high mortality rates. Non-reproductive period: The average number of years of study is directly associated with the high mortality rate.
Oliveira et al. (2020)¹¹11 Oliveira NPD, Siqueira CAS, Lima KYN, Cancela MC, Souza DLB. Association of cervical and breast cancer mortality with socioeconomic indicators and availability of health services. Cancer Epidemiol 2020; 64:101660., Brazil (RIAU), ecological study.	Breast (C50); Cervix (C53)	Gini Index; HDI; Income per capita; female illiteracy rate; % of poverty.	Standardized rates of cervical neoplasm mortality was higher in Brazilian regions with the highest rates of social inequality and the lowest levels of HDI. The opposite was observed for standardized breast neoplasia standard rates, whose most developed areas had higher standardized adjusted values.
Fernandes et al. (2020)⁴⁴44 Fernandes GA, Menezes FDS, Silva LF, Antunes JLF, Toporcov TN. Inequalities in lung cancer mortality trends in Brazil, 2000-2015. Sci Rep 2020; 10(1):19164., Brazil (states), temporal study series.	Lung (C33-C34)	HDI	Lung neoplasm mortality rates in both sexes by state were greater in those with higher HDI compared to those with lower HDI, most of the time, but with a higher percentage reduction in mortality rates among states higher HDI.
Carvalho, Paes (2019)³⁴34 Carvalho JB, Paes NA. Socioeconomic inequalities in breast cancer mortality in microregions of the Brazilian Northeast. Rev Bras Saude Materno Infant 2019; 19(2):391-400., Northeast Region, ecological study.	Breast (C50)	Environmental condition: % household households; sewerage system; Garbage collection service. Socioeconomic condition: illiteracy; poverty; % of economically active women; nominal income of up to one minimum wage; live alone.	Microregions with lower percentage of illiterate elderly and in poverty situations and higher percentage of elderly residents of homes with piped water showed higher mortality rates by breast neoplasms.
Figueiredo, Adami (2019)³⁹39 Figueiredo FWS, Adami F. Effects of the high-inequality of income on the breast cancer mortality in Brazil. Sci Rep 2019; 9(1):4173., Brazil (states), ecological study.	Breast (C50)	Gini Index.	Higher mortality from breast neoplasia in states with high income inequality (Gini Index> 0.62) compared to low/medium income inequality (Gini Index ≤ 0.62), after adjustments by HDI and aging index.
Sakamoto et al. (2019)²⁸28 Sakamoto AJ, Brizon VSC, Bulgareli JV, Ambrosano GMB, Hebling E. Influence of municipal socioeconomic indices on mortality rates for oral and oropharyngeal cancer in older adults in the State of São Paulo, Brazil. Rev Bras Epidemiol 2019; 22:e190013., São Paulo State, ecological study.	Oral (C00-C06); Oropharynx (C10)	Municipal HDI; Mean income per capita.	Mortality by oral and oropharynx neoplasms has significantly reduced the increase in municipal HDI and per capita average income
Vale et al. (2019)⁷7 Vale DB, Sauvaget C, Murillo R, Muwonge R, Zeferino LC, Sankaranarayanan R. Correlation of cervical cancer mortality with fertility, access to health care and socioeconomic indicators. Rev Bras Ginecol Obstet 2019; 41(4):249-255., Brazil (states), ecological study.	Cervix (CID not specified)	HDI; Income per capita; Illiteracy rate (% of population > 15 who cannot read and write); PIB; Fertility rate	The fertility rate positively associated with cervical neoplasm mortality rates.
Moi et al. (2018)²⁹29 Moi GP, Silva AMC, Galvão ND, Meneghim MC, Pereira AC. Spatial analysis of the death associated factors due oral cancer in Brazil: an ecological study. BMC Oral Health 2018; 18(1):14., Brazil (states), ecological study.	Oral (C00-C14)	Illiteracy rate; % of population whose household income per capita is < half a minimum salary; HDI.	The HDI presented significant inverse association with oral neoplasm mortality rates.
Rocha-Brischiliari et al. (2018)³⁰30 Rocha-Brischiliari SC, Andrade L, Nihei OK, Brischiliari A, Hortelan MDS, Carvalho MDB, Pelloso SM. Spatial distribution of breast cancer mortality: socioeconomic disparities and access to treatment in the state of Parana, Brazil. PloS One 2018; 13(10):e0205253., Paraná State, transversal retrospective ecological study.	Breast (C50)	Illiteracy (% of illiterate ≥ 15); Income per capita; Degree of urbanization; Municipal HDI.	The illiteracy rate showed inverse correlation with the mortality rate due to breast neoplasms.
Oliveira et al. (2018)³¹31 Oliveira MM, Latorre MRDO, Tanaka LF, Rossi BM, Curado MP. Disparities in colorectal cancer mortality across Brazilian states. Rev Bras Epidemiol 2018; 21:e180012., Brazil (states/reguions), ecological study and temporal series.	Colorectal (C18-20)	PIB; Income per capita; Gini Index.	The increase in the mortality rate due to colorectal neoplasia was significant for men in 10 states, and in 14 states and in Brazil as a whole for women, when adjusted by socioeconomic indicators. There was no national association standard; the growth in the mortality rate was present in some states with higher per capita GDP, and in states that still have higher income inequality, especially in states in the Northeast region.
Figueiredo, Adami (2018)³⁵35 Figueiredo FWDS, Adami F. Income inequality and mortality owing to breast cancer: evidence from Brazil. Clin Breast Cancer 2018; 18(4):e651--e658., Brazil (states), ecological study.	Breast (C50)	Gini Index; Palma Index; Theil-L Index; Ratio of income quintiles.	Increased income increases assessed by Gini, Palma and Theil-L rates were related to increases in standardized and proportional mortality by breast neoplasia.
Barbosa et al. (2016)³²32 Barbosa IR, Costa ICC, Pérez MMB, Souza DLB. Desigualdades socioeconômicas e mortalidade por câncer: um estudo ecológico no Brasil. Rev Bras Prom Saude 2016; 29(3):350-356., 268 Municipalities (118 in the following regions: Southeast, 56 Northeast, 52 South, 25 Centre-west, 17 North, ecological study.	All sites (C00-C97)	Gini Index; Income per capita; Life expectancy; Illiteracy rate of persons > 25.	The best socioeconomic condition is directly associated with higher risk of mortality from neoplasms. In Brazil, the South and Southeast regions recorded the highest mortality rates and the best socioeconomic indicators, expressed by income and life expectancy.
Girianelli et al. (2014)⁴³43 Girianelli VR, Gamarra CJ, Silva GA. Disparities in cervical and breast cancer mortality in Brazil. Rev Saude Publica 2014; 48(3):459-467., Brazil (Regions/Capitals/Interior), temporal study series.	Breast (174; C50); Cervix (180; C53)	Positive Indicators: HDI; % of individuals at age ≤ 25 years with over 11 years of education; % of individuals in households with electricity; % of people in plumbing households. Negative Indicators: % of the population aged ≤ 25 illiterate; % of People Living Below the Poverty Line; Mortality Rate in Children <5/1,000 Live Births; % of Female Heads of Households, Single and with Children ≤ 15.	Breast: In capitals, % of individuals aged ≤ 25 years, over 11 years of schooling, and % of people in households with mains water were positively associated with increased mortality rate. The reduction in mortality occurred when the % of a household head, single and with children ≤ 15 years increased. Inside, the relationship is direct with positive and inverse indicators with the negative indicators. Cervical: In the capitals, the mortality rate is inversely correlated to the indicators of better socioeconomic conditions and directly correlated to negative indicators; Inside, only % of individuals living below the poverty line was related to increased mortality.
Ferreira et al. (2012)⁴⁰40 Ferreira MAF, Gomes MN, Michels FAS, Dantas AA, Latorre MRDO. Social inequality in morbidity and mortality from oral and oropharyngeal cancer in the city of São Paulo, Brazil: 1997-2008. Cad Saude Publica 2012; 28(9):1663-1673., São Paulo Municipality , ecological study.	Oral/Orofaringe (C00-C10; C14.8)	Gini Index; HDI.	Negative correlation between mortality rates and HDI and Gini Index.
Müller et al. (2011)³⁶36 Müller EV, Biazevic MGH, Antunes JLF, Crosato EM. Socioeconomic trends and differentials in mortality due to cervical cancer in the State of Paraná (Brazil), 1980-2000. Cien Saude Colet 2011; 16(5):2495-2500., Paraná State, temporal study series.	Cervix (180; C53)	Family income; HDI; Unemployment rate; Gini Index; Illiteracy rate; Educational level indicators.	The trend toward an increased mortality rate was associated with worst illiteracy rates (higher % of residents with <4 years of study), income per capita and HDI lower than regional ones that presented stable trends.
Borges et al. (2009)⁴¹41 Borges DML, Sena MF, Ferreira MAF, Roncalli AG. Mortality for oral cancer and socioeconomic status in Brazil. Cad Saude Publica 2009; 25(2):321-327., Brazil (regions), ecological study.	Oral (CID not specified)	Gini Index; Income per capita; Municipal HDI; Infant mortality.	A very significant correlation between municipal HDI and oral neoplasia was evidenced, as well as with the sub-items of this index, demonstrating that the better the municipal development the higher the oral neoplasm index, among all deaths, finding it repeats for correlation with the income per capita.
Antunes et al. (2008)⁴²42 Antunes JLF, Borrell C, Rodríguez-Sanz M, Pérez G, Biazevic MGH, Wünsch-Filho V. Sex and socioeconomic inequalities of lung cancer mortality in Barcelona, Spain and São Paulo, Brazil. Eur J Cancer Prev 2008; 17(5):399-405., São Paulo Municipality, ecological study.	Lung (162; C33-C34)	% of heads of household who declare absence of formal income; % of household heads with less than 4 years schooling; % of heads of family that had completed university courses; HDI.	The association between HDI and lung neoplasia mortality was positive, the richest areas having a higher average mortality rate.

ABRASCO - Associação Brasileira de Saúde Coletiva Av. Brasil, 4036 - sala 700 Manguinhos, 21040-361 Rio de Janeiro RJ - Brazil, Tel.: +55 21 3882-9153 / 3882-9151 - Rio de Janeiro - RJ - Brazil
E-mail: cienciasaudecoletiva@fiocruz.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Chief editors:

Maria Cecília de Souza Minayo, Romeu Gomes, Antônio Augusto Moura da Silva