Tendência secular de mortalidade e morbidade por câncer do colo do útero nas regiões do Brasil

Abstract

Cervical cancer continues to be a significant public health challenge worldwide. Despite well-established prevention and screening methods, the disease still exhibits high rates of incidence, morbidity, and mortality among women. The objective of this research is to analyze the long-term trends in mortality and morbidity caused by cervical cancer in Brazil and its regions. This study utilizes a population and ecological approach with time series analysis, examining cases of cervical cancer-related deaths and hospitalizations across all age groups in the five Brazilian regions: Midwest, Northeast, North, Southeast, and South. The data used for analysis were obtained from the Department of Informatics of the Unified Health System. Information on deaths came from the Mortality Information System (SIM) and hospitalizations from the Hospital Information System (SIH). The specific codes employed to retrieve the data were 180 (Malignant neoplasm of the cervix) according to the International Classification of Diseases (ICD) 9 and C53 (Malignant neoplasm of the cervix) according to ICD-10. Crude rates, age-specific rates, and age-standardized rates were calculated for each year and age group, using both the Brazilian population and the world population as references. The age groups were categorized into 20 to 44 years, 45 to 64 years, and 65 years or older, excluding women below 19 years of age due to their low representation (less than 0.5%). The mortality trend was calculated using the Joinpoint Regression Program, version 4.9.1.0, National Cancer Institute, USA. The statistical significance adopted was 5.0%, identified through the Monte Carlo Permutation test, and the Confidence Interval (CI) was 95.0%. There were 171,793 thousand deaths recorded from 1980 to 2021 and 736,491 thousand hospitalizations from 1992 to 2021. Mortality rates from cervical cancer increased in the North and Northeast and decreased in other places. Hospitalization rates have reduced in Brazil and in all regions. Regarding mortality trends, there was a reduction in the Central- West (AAPC -1,3; CI -1,5; -1,1) and Southeast (AAPC -0,9; CI -1,4; -0,5), stability in Brazil (AAPC -0,3; CI -1,0; 0,4), North (AAPC 0,6; CI -0,1; 1,3) and South (AAPC 0,0; CI -0,5; 0,5) and an increase in the Northeast (AAPC 0,6; CI 0,3; 0,8). For hospitalizations, Brazil (AAPC -2,5; CI -3,9; -1,0), Northeast (AAPC -3,2; CI -4,5; -1,9) and Southeast (AAPC -2,9; CI -4,7; -1,2) showed decreasing trends and the Central- West (AAPC -2,6; CI -5,6; 0,4), North (AAPC -1,2; CI -5,0; 2,8) and South (AAPC -1,7; CI -3,6; 0,2) regions-maintained stability. Regional disparities were evident in this study, where the North and Northeast had the highest mortality rates. Despite decreasing and stationary trends, cervical cancer still represents an important cause of illness and death in Brazilian women.