Panorama espaço-temporal do câncer colorretal no Brasil: morbimortalidade, acesso ao tratamento e associação com determinantes sociais de saúde (1980-2023)

Abstract

Colorectal cancer (CRC) represents a major challenge for public health in Brazil due to its high mortality, marked regional disparities, and the fragility of oncology care during health crises. This study aimed to comprehensively examine mortality trends and spatial patterns, the impact of the COVID-19 pandemic on access to treatment, and inequalities in estimated incidence, considering the social determinants of health in Brazil. An ecologic study were conducted using secondary data. First, temporal trends and spatiotemporal clusters of CRC mortality between 1980 and 2021 were analyzed using regression methods and spatial statistics. Subsequently, the impact of COVID-19 on access to treatment w was investigated by analyzing different therapeutic modalities and the interval from diagnosis to treatment initiation, using interrupted time-series analysis and spatial analysis across Health Regions. Finally, municipal CRC incidence for 2024 was estimated based on mortality data and cancer registries, exploring its spatial distribution and its relationship with social, demographic, and health system factors through spatial regression. The results showed a sustained increase and geographic expansion of mortality over recent decades, with high-risk concentrations in the South and Southeast regions and the emergence of clusters in capitals and metropolitan areas of the Northeast. The pandemic caused substantial disruptions in access to treatment, particularly for surgery and chemotherapy, with more pronounced effects in historically vulnerable Health Regions, exacerbating regional inequalities and keeping access below expected levels through 2022. Estimated incidence revealed profound spatial disparities, with higher rates in the South, Southeast, and parts of the Midwest, and lower rates in the North and Northeast. The associations between incidence and social determinants varied across space and scale, reflecting differences in risk as well as inequalities in diagnostic capacity and health service infrastructure. In conclusion, CRC in Brazil exhibits a complex dynamic marked by temporal, spatial, and access-related inequalities, which are intensified during crisis contexts. These findings underscore the importance of integrated, territorially sensitive public policies aimed at strengthening regional oncology networks, expanding equitable early diagnosis, promoting health, and enhancing service resilience. Continuous population-based surveillance and the incorporation of social determinants of health are crucial to reducing inequalities and mitigating the future impact of CRC.