Analysis of the effects of the age-period-birth cohort on cervical cancer mortality in the Brazilian Northeast

PLoS One. 2020 Feb 19;15(2):e0226258. doi: 10.1371/journal.pone.0226258. eCollection 2020.

Abstract

Cervical cancer (CC) is a public health problem with a high disease burden and mortality in developing countries. In Brazil, areas with low human development index have the highest incidence rates of Brazil and upward temporal trend for this disease. The Northeast region has the second highest incidence of cervical cancer (20.47 new cases / 100,000 women). In this region, the mortality rates are similar to rates in countries that do not have a health system with a universal access screening program, as in Brazil. Thus, this study aimed to analyze the effects of age, period and birth cohorts on mortality from cervical cancer in the Northeast region of Brazil. Estimable functions predicted the effects of age, period and birth cohort. The average mortality rate was 10.35 deaths per 100,000 women during the period analyzed (1980-2014). The highest mortality rate per 100,000 women was observed in Maranhão (24.39 deaths), and the lowest mortality rate was observed in Bahia (11.24 deaths). According to the period effects, only the state of Rio Grande do Norte showed a reduction in mortality risk in the five years of the 2000s. There was a reduction in mortality risk for birth cohorts of women after the 1950s, except in Maranhão State, which showed an increasing trend in mortality risk for younger generations. We found that the high rates of cervical cancer mortality in the states of northeastern Brazil remain constant over time. Even after an increase in access to health services in the 2000s, associated with increased access to the cancer care network, which includes early detection (Pap Test), cervical cancer treatment and palliative care. However, it is important to note that the decreased risk of death and the mortality rates from CC among women born after the 1960s may be correlated with increased screening coverage, as well as increased access to health services for cancer treatment observed in younger women.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Brazil / epidemiology
  • Cohort Studies
  • Early Detection of Cancer
  • Female
  • Health Services Accessibility
  • Humans
  • Incidence
  • Mass Screening / economics
  • Middle Aged
  • Mortality
  • Papanicolaou Test
  • Uterine Cervical Neoplasms / epidemiology*
  • Uterine Cervical Neoplasms / mortality*
  • Young Adult

Grants and funding

This article is a product of a project coordinated by the main author, Meira KC, and funded by the National Scientific and Technological Development (CNPQ) (http://www.cnpq.br/) and Coordination for the Improvement of Higher Education, for promoting this research (CAPES-Financing Code 001). The funders had no role in study design, data collection.