Nível socioeconômico e sobrevida líquida de pacientes com câncer no Brasil: análise de dados populacionais dos municípios de Aracaju (SE) e Curitiba (PR), 1996 a 2012
Autor(a) principal: | |
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Data de Publicação: | 2020 |
Outros Autores: | |
Tipo de documento: | Tese |
Idioma: | por |
Título da fonte: | Biblioteca Digital de Teses e Dissertações da UERJ |
Texto Completo: | http://www.bdtd.uerj.br/handle/1/20691 |
Resumo: | Cancer incidence is increasing worldwide, and the disease is related to significant morbidity and mortality. Several international studies have pointed out the existence of inequities related to the prognosis of the disease in terms of socioeconomic conditions and ethno-racial characteristics. The present study aims to analyze the impact of social and economic aspects on cancer net survival including patients diagnosed with malignant neoplasms of breast, lung, prostate, cervix uteri and colorectal tumors, in the municipalities of Aracaju (SE) and Curitiba (PR), among the years 1996 and 2012. A retrospective cohort was compiled with data from Population-based Cancer Registries. Stratification by socioeconomic level was performed through the construction of a contextual indicator based on information on income and education, attributed to individuals according to region of residence. Flexible multilevel models were built to analyze the excess mortality hazard related to the diagnosis of cancer according to socioeconomic level, race-color, age and year of diagnosis, for each sex tumor site couple. The mortality hazard ratios and the age adjusted net survival percentages of 2, 5 and 8 years from the date of diagnosis were estimated. Information on a total of 28,005 cancer cases in the two municipalities was analyzed. During the study period, there was an increase in net survival percentages for all types of cancer, even for the most aggressive tumors. Patients residing in Curitiba had higher survival rates compared to patients from Aracaju, even after stratification by socioeconomic level. Differences in terms of socioeconomic level were found for the populations of both municipalities, showing greater magnitude in Curitiba. There was no reduction of these differences over the study period. The results of the present study indicate an increase in socioeconomic, ethno-racial and regional inequalities in cancer survival for patients in these two Brazilian cities during the past three decades. These findings highlight the importance of strengthening cancer care policies with focus on reducing inequalities in access to diagnostic and therapeutic services |
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Silva, Gulnar Azevedo ehttp://lattes.cnpq.br/5225298757437978Melo, Andréia Cristina deCherchiglia, Mariângela LealMonteiro, Gina Torres RegoValente, Joaquim Gonçalveshttp://lattes.cnpq.br/9280482061886248Renna Junior, Nelson Luiznelsonrenna@gmail.com2023-11-27T15:26:20Z2020-04-28RENNA JUNIOR, Nelson Luiz. Nível socioeconômico e sobrevida líquida de pacientes com câncer Brasil: análise de dados populacionais dos municípios de Aracaju (SE) e Curitiba (PR), 1996 a 2012. 2020. 149 f. Tese (Doutorado em Saúde Coletiva) – Instituto de Medicina Social Hesio Cordeiro, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, 2020.http://www.bdtd.uerj.br/handle/1/20691Cancer incidence is increasing worldwide, and the disease is related to significant morbidity and mortality. Several international studies have pointed out the existence of inequities related to the prognosis of the disease in terms of socioeconomic conditions and ethno-racial characteristics. The present study aims to analyze the impact of social and economic aspects on cancer net survival including patients diagnosed with malignant neoplasms of breast, lung, prostate, cervix uteri and colorectal tumors, in the municipalities of Aracaju (SE) and Curitiba (PR), among the years 1996 and 2012. A retrospective cohort was compiled with data from Population-based Cancer Registries. Stratification by socioeconomic level was performed through the construction of a contextual indicator based on information on income and education, attributed to individuals according to region of residence. Flexible multilevel models were built to analyze the excess mortality hazard related to the diagnosis of cancer according to socioeconomic level, race-color, age and year of diagnosis, for each sex tumor site couple. The mortality hazard ratios and the age adjusted net survival percentages of 2, 5 and 8 years from the date of diagnosis were estimated. Information on a total of 28,005 cancer cases in the two municipalities was analyzed. During the study period, there was an increase in net survival percentages for all types of cancer, even for the most aggressive tumors. Patients residing in Curitiba had higher survival rates compared to patients from Aracaju, even after stratification by socioeconomic level. Differences in terms of socioeconomic level were found for the populations of both municipalities, showing greater magnitude in Curitiba. There was no reduction of these differences over the study period. The results of the present study indicate an increase in socioeconomic, ethno-racial and regional inequalities in cancer survival for patients in these two Brazilian cities during the past three decades. These findings highlight the importance of strengthening cancer care policies with focus on reducing inequalities in access to diagnostic and therapeutic servicesO câncer é uma doença de incidência crescente e que está relacionada a morbidade e mortalidade significativas em todo o mundo. Diversos estudos internacionais têm apontado a existência de iniquidades relacionadas ao prognóstico da doença em termos de condições socioeconômicas e características etnorraciais. O presente trabalho tem por objetivo analisar o impacto dos aspectos sociais e econômicos na sobrevida líquida de pacientes com diagnóstico de neoplasias malignas de mama, pulmão, próstata, colo uterino e tumores colorretais nos municípios de Aracaju (SE) e Curitiba (PR), entre os anos de 1996 e 2012. Para tanto foi composta uma coorte retrospectiva com dados dos Registros de Câncer de Base Populacional. A estratificação por nível socioeconômico foi realizada a partir da construção de um indicador contextual baseado em informações de renda e escolaridade, atribuído aos indivíduos de acordo com região de moradia. Construiu-se modelos multinível flexíveis para análise do excesso de hazard de mortalidade relacionado ao diagnóstico de câncer em função de nível socioeconômico, raça-cor, idade e ano do diagnóstico, para cada dupla sexo-tipo de tumor. As razões de hazard de mortalidade e os percentuais de sobrevida líquida, ajustados por idade, de 2, 5 e 8 anos a contar da data do diagnóstico foram estimados. Foram analisadas informações relativas a um total de 28.005 casos de câncer nos dois municípios. Durante o período de estudo, observou-se aumento nos percentuais de sobrevida líquida para todos os tipos de câncer mesmo para os tumores mais agressivos. Pacientes com residência em Curitiba apresentaram percentuais de sobrevida mais elevados em comparação com pacientes de Aracaju, mesmo após estratificação por nível socioeconômico. Diferenças em termos de nível socioeconômico foram encontradas para as populações de ambos os municípios, apresentaram maior magnitude na população de Curitiba. Não se observou tendência de redução dessas diferenças ao longo do período de estudo. Os resultados do presente trabalho indicam ampliação das desigualdades socioeconômicas, etnorraciais e regionais na sobrevida de portadores de câncer no Brasil durante as décadas de 1990 e 2000. Estes achados ressaltam a importância do fortalecimento das políticas de atenção oncológica com foco na redução de desigualdades no acesso a serviços diagnósticos e terapêuticosSubmitted by Thais Vieira CB/C (thaisvieira.uerj@gmail.com) on 2023-11-27T15:26:20Z No. of bitstreams: 1 Tese - Nelson Renna Junior - 2020 - Completa.pdf: 1721138 bytes, checksum: 0e6fb903c84bb5b3288316a1839843bd (MD5)Made available in DSpace on 2023-11-27T15:26:20Z (GMT). No. of bitstreams: 1 Tese - Nelson Renna Junior - 2020 - Completa.pdf: 1721138 bytes, checksum: 0e6fb903c84bb5b3288316a1839843bd (MD5) Previous issue date: 2020-04-28application/pdfporUniversidade do Estado do Rio de JaneiroPrograma de Pós-Graduação em Saúde ColetivaUERJBrasilCentro Biomédico::Instituto de Medicina Social Hesio CordeiroMalignant neoplasmsSurvival AnalysisRegression AnalysisSocial inequitySocioeconomic factorsBreast neoplasmsUterine cervical neoplasmsProstatic neoplasmsLung neoplasmsColorectal neoplasmsNeoplasiasAnálise de sobrevidaAnálise de regressãoIniquidade socialFatores socioeconômicosEpidemiologiaNeoplasias malignasAnálise de regressãoNeoplasias da mamaNeoplasias do colo do úteroNeoplasias da próstataNeoplasias pulmonaresNeoplasias colorretaisCIENCIAS DA SAUDE::SAUDE COLETIVA::EPIDEMIOLOGIANível socioeconômico e sobrevida líquida de pacientes com câncer no Brasil: análise de dados populacionais dos municípios de Aracaju (SE) e Curitiba (PR), 1996 a 2012Socioeconomic status and cancer survival in Brazil: analysis of populational data from the municipalities of Aracaju (SE) e Curitiba (PR), 1996 to 2012info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/doctoralThesisinfo:eu-repo/semantics/openAccessreponame:Biblioteca Digital de Teses e Dissertações da UERJinstname:Universidade do Estado do Rio de Janeiro (UERJ)instacron:UERJORIGINALTese - Nelson Renna Junior - 2020 - Completa.pdfTese - Nelson Renna Junior - 2020 - Completa.pdfapplication/pdf1721138http://www.bdtd.uerj.br/bitstream/1/20691/2/Tese+-+Nelson+Renna+Junior+-+2020+-+Completa.pdf0e6fb903c84bb5b3288316a1839843bdMD52LICENSElicense.txtlicense.txttext/plain; charset=utf-82123http://www.bdtd.uerj.br/bitstream/1/20691/1/license.txte5502652da718045d7fcd832b79fca29MD511/206912024-02-26 20:20:41.795oai:www.bdtd.uerj.br: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Biblioteca Digital de Teses e Dissertaçõeshttp://www.bdtd.uerj.br/PUBhttps://www.bdtd.uerj.br:8443/oai/requestbdtd.suporte@uerj.bropendoar:29032024-02-26T23:20:41Biblioteca Digital de Teses e Dissertações da UERJ - Universidade do Estado do Rio de Janeiro (UERJ)false |
dc.title.por.fl_str_mv |
Nível socioeconômico e sobrevida líquida de pacientes com câncer no Brasil: análise de dados populacionais dos municípios de Aracaju (SE) e Curitiba (PR), 1996 a 2012 |
dc.title.alternative.eng.fl_str_mv |
Socioeconomic status and cancer survival in Brazil: analysis of populational data from the municipalities of Aracaju (SE) e Curitiba (PR), 1996 to 2012 |
title |
Nível socioeconômico e sobrevida líquida de pacientes com câncer no Brasil: análise de dados populacionais dos municípios de Aracaju (SE) e Curitiba (PR), 1996 a 2012 |
spellingShingle |
Nível socioeconômico e sobrevida líquida de pacientes com câncer no Brasil: análise de dados populacionais dos municípios de Aracaju (SE) e Curitiba (PR), 1996 a 2012 Renna Junior, Nelson Luiz Malignant neoplasms Survival Analysis Regression Analysis Social inequity Socioeconomic factors Breast neoplasms Uterine cervical neoplasms Prostatic neoplasms Lung neoplasms Colorectal neoplasms Neoplasias Análise de sobrevida Análise de regressão Iniquidade social Fatores socioeconômicos Epidemiologia Neoplasias malignas Análise de regressão Neoplasias da mama Neoplasias do colo do útero Neoplasias da próstata Neoplasias pulmonares Neoplasias colorretais CIENCIAS DA SAUDE::SAUDE COLETIVA::EPIDEMIOLOGIA |
title_short |
Nível socioeconômico e sobrevida líquida de pacientes com câncer no Brasil: análise de dados populacionais dos municípios de Aracaju (SE) e Curitiba (PR), 1996 a 2012 |
title_full |
Nível socioeconômico e sobrevida líquida de pacientes com câncer no Brasil: análise de dados populacionais dos municípios de Aracaju (SE) e Curitiba (PR), 1996 a 2012 |
title_fullStr |
Nível socioeconômico e sobrevida líquida de pacientes com câncer no Brasil: análise de dados populacionais dos municípios de Aracaju (SE) e Curitiba (PR), 1996 a 2012 |
title_full_unstemmed |
Nível socioeconômico e sobrevida líquida de pacientes com câncer no Brasil: análise de dados populacionais dos municípios de Aracaju (SE) e Curitiba (PR), 1996 a 2012 |
title_sort |
Nível socioeconômico e sobrevida líquida de pacientes com câncer no Brasil: análise de dados populacionais dos municípios de Aracaju (SE) e Curitiba (PR), 1996 a 2012 |
author |
Renna Junior, Nelson Luiz |
author_facet |
Renna Junior, Nelson Luiz nelsonrenna@gmail.com |
author_role |
author |
author2 |
nelsonrenna@gmail.com |
author2_role |
author |
dc.contributor.advisor1.fl_str_mv |
Silva, Gulnar Azevedo e |
dc.contributor.advisor1Lattes.fl_str_mv |
http://lattes.cnpq.br/5225298757437978 |
dc.contributor.referee1.fl_str_mv |
Melo, Andréia Cristina de |
dc.contributor.referee2.fl_str_mv |
Cherchiglia, Mariângela Leal |
dc.contributor.referee3.fl_str_mv |
Monteiro, Gina Torres Rego |
dc.contributor.referee4.fl_str_mv |
Valente, Joaquim Gonçalves |
dc.contributor.authorLattes.fl_str_mv |
http://lattes.cnpq.br/9280482061886248 |
dc.contributor.author.fl_str_mv |
Renna Junior, Nelson Luiz nelsonrenna@gmail.com |
contributor_str_mv |
Silva, Gulnar Azevedo e Melo, Andréia Cristina de Cherchiglia, Mariângela Leal Monteiro, Gina Torres Rego Valente, Joaquim Gonçalves |
dc.subject.eng.fl_str_mv |
Malignant neoplasms Survival Analysis Regression Analysis Social inequity Socioeconomic factors Breast neoplasms Uterine cervical neoplasms Prostatic neoplasms Lung neoplasms Colorectal neoplasms |
topic |
Malignant neoplasms Survival Analysis Regression Analysis Social inequity Socioeconomic factors Breast neoplasms Uterine cervical neoplasms Prostatic neoplasms Lung neoplasms Colorectal neoplasms Neoplasias Análise de sobrevida Análise de regressão Iniquidade social Fatores socioeconômicos Epidemiologia Neoplasias malignas Análise de regressão Neoplasias da mama Neoplasias do colo do útero Neoplasias da próstata Neoplasias pulmonares Neoplasias colorretais CIENCIAS DA SAUDE::SAUDE COLETIVA::EPIDEMIOLOGIA |
dc.subject.por.fl_str_mv |
Neoplasias Análise de sobrevida Análise de regressão Iniquidade social Fatores socioeconômicos Epidemiologia Neoplasias malignas Análise de regressão Neoplasias da mama Neoplasias do colo do útero Neoplasias da próstata Neoplasias pulmonares Neoplasias colorretais |
dc.subject.cnpq.fl_str_mv |
CIENCIAS DA SAUDE::SAUDE COLETIVA::EPIDEMIOLOGIA |
description |
Cancer incidence is increasing worldwide, and the disease is related to significant morbidity and mortality. Several international studies have pointed out the existence of inequities related to the prognosis of the disease in terms of socioeconomic conditions and ethno-racial characteristics. The present study aims to analyze the impact of social and economic aspects on cancer net survival including patients diagnosed with malignant neoplasms of breast, lung, prostate, cervix uteri and colorectal tumors, in the municipalities of Aracaju (SE) and Curitiba (PR), among the years 1996 and 2012. A retrospective cohort was compiled with data from Population-based Cancer Registries. Stratification by socioeconomic level was performed through the construction of a contextual indicator based on information on income and education, attributed to individuals according to region of residence. Flexible multilevel models were built to analyze the excess mortality hazard related to the diagnosis of cancer according to socioeconomic level, race-color, age and year of diagnosis, for each sex tumor site couple. The mortality hazard ratios and the age adjusted net survival percentages of 2, 5 and 8 years from the date of diagnosis were estimated. Information on a total of 28,005 cancer cases in the two municipalities was analyzed. During the study period, there was an increase in net survival percentages for all types of cancer, even for the most aggressive tumors. Patients residing in Curitiba had higher survival rates compared to patients from Aracaju, even after stratification by socioeconomic level. Differences in terms of socioeconomic level were found for the populations of both municipalities, showing greater magnitude in Curitiba. There was no reduction of these differences over the study period. The results of the present study indicate an increase in socioeconomic, ethno-racial and regional inequalities in cancer survival for patients in these two Brazilian cities during the past three decades. These findings highlight the importance of strengthening cancer care policies with focus on reducing inequalities in access to diagnostic and therapeutic services |
publishDate |
2020 |
dc.date.issued.fl_str_mv |
2020-04-28 |
dc.date.accessioned.fl_str_mv |
2023-11-27T15:26:20Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
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info:eu-repo/semantics/doctoralThesis |
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doctoralThesis |
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publishedVersion |
dc.identifier.citation.fl_str_mv |
RENNA JUNIOR, Nelson Luiz. Nível socioeconômico e sobrevida líquida de pacientes com câncer Brasil: análise de dados populacionais dos municípios de Aracaju (SE) e Curitiba (PR), 1996 a 2012. 2020. 149 f. Tese (Doutorado em Saúde Coletiva) – Instituto de Medicina Social Hesio Cordeiro, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, 2020. |
dc.identifier.uri.fl_str_mv |
http://www.bdtd.uerj.br/handle/1/20691 |
identifier_str_mv |
RENNA JUNIOR, Nelson Luiz. Nível socioeconômico e sobrevida líquida de pacientes com câncer Brasil: análise de dados populacionais dos municípios de Aracaju (SE) e Curitiba (PR), 1996 a 2012. 2020. 149 f. Tese (Doutorado em Saúde Coletiva) – Instituto de Medicina Social Hesio Cordeiro, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, 2020. |
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http://www.bdtd.uerj.br/handle/1/20691 |
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por |
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por |
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Universidade do Estado do Rio de Janeiro |
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UERJ |
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Brasil |
dc.publisher.department.fl_str_mv |
Centro Biomédico::Instituto de Medicina Social Hesio Cordeiro |
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Universidade do Estado do Rio de Janeiro |
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