title: Socioeconomic differentials and mortality from colorectal cancer in large cities in Brazil.
abstract: The objective of this study was to compare the mortality pattern of colorectal cancer according to the social development profile of the large Brazilian cities. This was an ecological study that used as units of analysis Brazilian municipalities that were considered to be large (i.e. over 100,000 inhabitants). The social indicators adopted were obtained from the Atlas of Human Development in Brazil. Mortality data came from the Mortality Information System (MIS), represented by codes C18, C19, and C20. For data analysis, municipalities were characterised according to the indicator profile used by multivariate classification cluster analysis. It was observed that the Southeast, South, and Midwest regions concentrated over 90% of cities in the group of more developed municipalities, while the North and Northeast regions were represented by 60% of cities in the group of less developed municipalities. The mortality pattern of colorectal cancer in both groups was different, with a higher average mortality rate from colorectal cancer for populations living in cities from the more developed group (p = 0.02). The mortality rate from this cancer was shown to be directly proportional to the Municipal Human Developlemnt Index (MHDI) and inversely proportional to the inequality indicator (p < 0.001); therefore the highest means were observed among the municipalities with better socioeconomic conditions. It is important to consider social disparities to ensure equity in healthcare policy management.
authors.affiliation: Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Brazil.
authors.forename: Viviane Gomes
authors.initials: VG
authors.lastname: Parreira
authors.affiliation: Universidade Federal do Rio Grande do Norte, Escola de Enfermagem de Natal, Brazil.
authors.forename: Karina Cardoso
authors.initials: KC
authors.lastname: Meira
authors.affiliation: Fundação Oswaldo Cruz, Escola Politécnica de Saúde Joaquim Venâncio, Brazil.
authors.forename: Raphael Mendonça
authors.initials: RM
authors.lastname: Guimarães
keywords: colorectal cancer; mortality; social indicators
references.citation: Breast. 2014 Apr;23(2):180-7
references.pmid: 24503143
references.citation: Lancet. 2011 Jun 4;377(9781):1949-61
references.pmid: 21561658
references.citation: Carcinogenesis. 2010 Jan;31(1):100-10
references.pmid: 19934210
references.citation: BMC Public Health. 2009 Jan 23;9:35
references.pmid: 19166582
references.citation: Eur J Cancer Prev. 2010 Mar;19(2):79-86
references.pmid: 20009937
references.citation: Lancet Oncol. 2012 Aug;13(8):790-801
references.pmid: 22658655
references.citation: Dis Colon Rectum. 2014 Sep;57(9):1082-9
references.pmid: 25101604
references.citation: Can J Gastroenterol Hepatol. 2014 Apr;28(4):191-7
references.pmid: 24729992
references.citation: Rev Saude Publica. 2011 Dec;45(6):1009-18
references.pmid: 22127651
references.citation: Lancet Oncol. 2015 Dec;16(16):1599-600
references.pmid: 26514947
references.citation: Lancet. 2005 Mar 19-25;365(9464):1099-104
references.pmid: 15781105
references.citation: Tohoku J Exp Med. 1960 Aug 25;72:91-103
references.pmid: 13749685
references.citation: Arq Gastroenterol. 2013 Jan-Mar;50(1):64-9
references.pmid: 23657309
references.citation: Cancer Causes Control. 2009 Jul;20(5):751-6
references.pmid: 19112603