Efeito da idade, do período e da coorte de nascimento na mortalidade por câncer de orofaringe nas unidades federativas brasileiras entre 1999 e 2023

Abstract

Oropharyngeal Cancer (OC) has demonstrated a global epidemiological transition in recent decades, occurring more frequently in young individuals non-exposed to tobacco or alcohol, the classic risk factors. This phenomenon, compared to an epidemic in some countries, is primarily driven by Human Papillomavirus (HPV) infection, associated with changes in sexual behavior. Age-Period-Cohort (APC) analysis identifies variations in the epidemiology of this neoplasm, enabling an investigation of this effect on OC mortality across Brazil's Federative Units (FU). This study aimed to analyze the APC effect on OC mortality in the 27 Brazilian FU from 1999 to 2023, identifying potential determinants for the observed effects and comparing them among the FU. This was an observational ecological study, since population aggregates were used as units of analysis. Thus, Population and death records, obtained from the Mortality Information System (SIM) and IBGE, were grouped into 5-year intervals. A Poisson regression model was applied, calculating the relative risk (RR) for each cohort. Data analysis utilized Deviance statistics and the approach proposed by Carstensen. A total of 77,293 deaths were identified, 84% of which were male. Results demonstrated regional heterogeneity. An increased risk of death from OC was observed in young cohorts in the North and Northeast, represented by Amazonas in the 1989-1993 cohort (RR= 5.40; 95%CI: 1.02 – 28.55) and Maranhão in the 2004-2008 cohort (RR= 13.38; 95%CI: 1.17 – 152.40). Furthermore, a reduction in mortality risk was recorded in more recent cohorts in the South, specifically in Paraná in the 1999-2003 cohort (RR= 0.20; 95%CI: 0.06 – 0.69), Santa Catarina in the 1994-1998 cohort (RR= 0.18; 95%CI: 0.06 – 0.53), and Rio Grande do Sul in the 1994-1998 cohort (RR= 0.22; 95%CI: 0.10 – 0.49); and in the Southeast, notably São Paulo in the 2004-2008 cohort (RR= 0.33; 95%CI: 0.11 – 0.97) and Rio de Janeiro in the 1999-2003 cohort (RR= 0.35; 95%CI: 0.14 – 0.91), in addition to Rondônia and Mato Grosso. Thus, Brazil presents heterogeneous OC mortality epidemiology; the South and Southeast reflect the success of tobacco control policies, while in the North and Northeast, HPV emerges as a potential cause of increased risk in current cohorts. Therefore, the need for expanded HPV vaccination coverage and public policies focused on early diagnosis is evident.