Burden of occupational cancer in Brazil and federative units, 1990-2019

Data were extracted from the Global Burden of Disease (GBD) study. Deaths from cancer whose attributable risk factor was occupational carcinogens were considered. Spatial analysis was performed with the first and last years of the series (1990 and 2019). Age-adjusted mortality rates were used to estimate the global Moran’s Index (Moran’s I), and the local indicator of spatial association (LISA) to identify clusters in the country with the respective statistical significance. The occupational cancer mortality rate, adjusted for age, was analyzed based on its trend for Brazil and federative units, in the period between 1990 and 2019.

Results:

Between 1990 and 2019, occupational cancer mortality rate showed a decreasing trend (R²=0.62; p<0.001) as well as the burden of disease indicator — DALY (R²=0.84; p<0.001). However, mortality is increasing in most states, suggesting that a minority of federative units induce the country’s global trend. There is also the development of a spatial pattern of autocorrelation, indicating clusters of states with low mortality and DALY rates in the Northeast and high values in the South of the country.

Conclusion:

The overall decreasing trend in the trend of occupational cancer masks the heterogeneity across states. This scenario may be associated with the diversity of economic activities, and suggests a decentralized and equitable plan for occupational cancer surveillance.

Keywords:
Occupational cancer; Neoplasms; Occupational health; Time series analysis

Region	FU	DALY						Deaths
		n		Rate				n		Rate
		n		Crude		Adjusted		n		Crude		Adjusted
		1990	2019	1990	2019	1990	2019	1990	2019	1990	2019	1990	2019
North	Acre	84	439	20.35	47.41	50.88	67.80	3	18	0.80	1.99	2.66	3.30
	Amapá	45	296	16.52	35.03	40.69	50.95	2	11	0.61	1.33	1.84	2.27
	Amazonas	535	1,876	25.81	44.46	63.24	61.65	20	78	0.96	1.85	2.88	2.86
	Pará	1,359	3,573	27.89	38.64	55.72	48.14	47	144	0.97	1.56	2.39	2.13
	Rondônia	282	1,026	25.52	57.75	75.56	62.50	9	42	0.84	2.39	3.96	2.91
	Roraima	64	232	30.53	38.71	92.67	57.15	2	9	1.01	1.52	4.36	2.85
	Tocantins	132	643	14.39	39.15	31.01	43.23	5	27	0.53	1.65	1.59	1.96
Northeast	Alagoas	528	1,585	20.65	43.30	38.09	47.72	21	64	0.83	1.75	1.73	2.04
	Bahia	3,076	9,289	25.38	58.23	41.97	56.50	111	380	0.91	2.38	1.68	2.36
	Ceará	2,093	6,966	32.27	69.42	48.60	68.83	79	310	1.22	3.09	1.95	3.14
	Maranhão	1,258	3,010	24.89	36.01	42.68	44.52	40	130	0.78	1.55	1.52	2.01
	Paraíba	837	2,208	25.61	50.37	36.91	46.91	37	99	1.12	2.26	1.67	2.06
	Pernambuco	1,820	5,477	24.92	54.08	39.19	53.19	73	234	0.99	2.31	1.75	2.39
	Piauí	519	1,304	19.60	35.31	34.02	34.60	19	55	0.72	1.50	1.49	1.47
	Rio Grande do Norte	526	1,860	21.36	49.74	33.01	47.24	22	81	0.90	2.17	1.45	2.07
	Sergipe	338	1,092	22.64	45.33	42.68	46.30	14	44	0.93	1.82	2.05	1.97
Southeast	Espírito Santo	755	2,329	28.68	58.59	48.09	51.23	28	97	1.06	2.45	2.13	2.26
	Minas Gerais	6,501	15,042	40.70	69.35	62.53	56.08	245	657	1.53	3.03	2.76	2.48
	Rio de Janeiro	9,152	13,907	70.03	78.69	87.89	61.07	332	611	2.54	3.46	3.60	2.74
	São Paulo	19,465	35,556	60.82	78.11	89.83	64.02	720	1,579	2.25	3.47	3.92	2.98
South	Paraná	3,422	8,636	39.93	75.82	65.16	62.97	127	378	1.48	3.32	2.93	2.92
	Rio Grande do Sul	9,615	16,354	103.90	144.71	137.17	104.05	363	744	3.92	6.58	5.80	4.77
	Santa Catarina	2,729	7,171	59.96	100.22	100.31	84.01	103	307	2.26	4.29	4.48	3.87
Midwest	Federal District	446	1,242	27.63	41.00	69.37	48.58	15	56	0.93	1.84	3.56	2.87
	Goiás	1,484	3,973	35.84	57.78	62.80	54.14	52	164	1.24	2.38	2.63	2.42
	Mato Grosso	530	1,885	26.69	52.37	58.66	52.71	19	75	0.94	2.08	2.59	2.33
	Mato Grosso do Sul	586	1,747	32.67	61.48	59.49	56.80	21	73	1.18	2.58	2.64	2.55
Brazil		68,180	148,718	45.81	68.64	71.39	61.69	2,526	6,469	1.70	2.99	3.02	2.79

Region	Federative Unit	Mortality
Region	Federative Unit	β₀	β₁	β₂	β₃	R²2 Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68(6): 394-424. https://doi.org/10.3322/caac.21492 https://doi.org/10.3322/caac.21492...	p-value	Trend
North	Acre	2.359	0.022	0.002	–	0.894	<0.001	Increasing
	Amapá	2.229	-0.002	-0.001	–	0.060	0.462	NS^* * NS: not significant.
	Amazonas	2.716	0.025	–	–	0.722	<0.001	Increasing
	Pará	1.824	0.003	–	–	0.081	0.143	NS^* * NS: not significant.
	Rondônia	2.649	0.009	–	–	0.174	0.027	Increasing
	Roraima	3.698	0.028	-0.002	–	0.779	<0.000	Decreasing
	Tocantins	1.418	-0.007	0.001	–	0.767	<0.001	Increasing
Northeast	Alagoas	1.403	0.010	0.001	–	0.845	<0.001	Increasing
	Bahia	1.437	0.021	–	–	0.954	<0.001	Increasing
	Ceará	1.995	0.024	-0.001	–	0.887	<0.001	Decreasing
	Maranhão	1.009	0.000	0.002	–	0.701	<0.001	Increasing
	Paraíba	1.669	0.013	–	–	0.649	<0.001	Increasing
	Pernambuco	1.814	0.009	0.001	–	0.654	<0.001	Increasing
	Piauí	1.074	0.012	0.001	–	0.540	<0.001	Increasing
	Rio Grande do Norte	1.546	0.017	0.001	–	0.925	<0.001	Increasing
	Sergipe	1.632	0.002	0.001	–	0.519	<0.001	Increasing
Southeast	Espírito Santo	1.737	-0.018	0.002	–	0.735	<0.001	Increasing
	Minas Gerais	2.212	0.025	0.001	–	0.817	<0.001	Decreasing
	Rio de Janeiro	3.139	-0.039	–	–	0.894	<0.001	Decreasing
	São Paulo	3.494	-0.028	–	–	0.918	<0.001	Decreasing
South	Paraná	2.765	-0.007	0.001	–	0.404	0.002	Increasing
	Rio Grande do Sul	5.496	-0.063	–	–	0.961	<0.001	Decreasing
	Santa Catarina	3.980	-0.025	–	–	0.751	<0.001	Decreasing
Midwest	Federal District	3.299	-0.016	-0.002	–	0.822	<0.001	Decreasing
	Goiás	2.072	-0.003	0.001	–	0.275	0.018	Increasing
	Mato Grosso	2.459	0.017	-0.001	–	0.491	<0.001	Decreasing
	Mato Grosso do Sul	2.729	0.005	-0.001	–	0.391	0.002	Decreasing
Brazil		2.713	-0.008	–	–	0.617	<0.001	Decreasing

Region	Federative Unit	DALY
Region	Federative Unit	β₀	β₁	β₂	β₃	R²2 Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68(6): 394-424. https://doi.org/10.3322/caac.21492 https://doi.org/10.3322/caac.21492...	p-value	Trend
North	Acre	50.539	0.516	0.027	–	0.902	<0.001	Increasing
	Amapá	44.294	-0.448	0.012	0.004	0.645	<0.001	Increasing
	Amazonas	59.297	0.842	-0.012	-0.004	0.753	<0.001	Decreasing
	Pará	42.097	0.210	-0.018	-0.002	0.326	0.022	Decreasing
	Rondônia	54.082	0.768	0.014	-0.005	0.681	<0.001	Decreasing
	Roraima	66.743	-0.848	–	–	0.920	<0.001	Decreasing
	Tocantins	29.815	0.164	0.016	–	0.836	<0.001	Decreasing
Northeast	Alagoas	33.458	0.646	0.011	-0.002	0.968	<0.001	Decreasing
	Bahia	33.983	0.479	–	–	0.938	<0.001	Increasing
	Ceará	46.356	0.411	-0.031	–	0.862	<0.001	Decreasing
	Maranhão	24.186	0.355	0.041	-0.004	0.929	<0.001	Decreasing
	Paraíba	38.834	0.919	0.016	-0.004	0.917	<0.001	Decreasing
	Pernambuco	41.972	0.245	–	–	0.628	<0.001	Increasing
	Piauí	24.446	0.654	0.009	-0.003	0.793	<0.001	Decreasing
	Rio Grande do Norte	36.336	0.428	–	–	0.955	<0.001	Increasing
	Sergipe	38.691	0.109	0.015	–	0.445	<0.001	Increasing
Southeast	Espírito Santo	40.040	0.044	0.016	-0.002	0.814	<0.001	Decreasing
	Minas Gerais	49.822	0.474	0.011	-0.004	0.741	<0.001	Decreasing
	Rio de Janeiro	70.104	-0.995	–	–	0.949	<0.001	Decreasing
	São Paulo	73.514	-0.638	–	–	0.921	<0.001	Decreasing
South	Rio Grande do Sul	116.905	-1.469	–	–	0.961	<0.001	Decreasing
	Paraná	58.093	0.204	-0.002	-0.002	0.692	<0.001	Decreasing
	Santa Catarina	82.482	-0.434	–	–	0.761	<0.001	Decreasing
Midwest	Federal District	54.618	-0.626	–	–	0.868	<0.001	Decreasing
	Goiás	44.291	0.215	0.011	-0.002	0.409	0.005	Decreasing
	Mato Grosso	54.611	0.942	-0.032	-0.005	0.702	<0.001	Decreasing
	Mato Grosso do Sul	58.350	0.097	-0.019	–	0.502	<0.001	Decreasing
Brazil		59.623	-0.272	–	–	0.844	<0.001	Decreasing

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[1] Corresponding author: Raphael Mendonça Guimarães. Avenida Brasil, 4.365, sala 904, Manguinhos, CEP: 21041-960, Rio de Janeiro (RJ), Brazil. E-mail: raphael.guimarães@fiocruz.br