title: Patterns of cervical cytological abnormalities according to the Human Development Index in the northeast region of Brazil.
abstract: Disparities in cancer incidence and mortality rates between regions arise due to differences in socioeconomic conditions and in human development factors. The major purpose of this study was to measure the role of the Human Development Index (HDI) in the pattern of cervical cytological abnormalities (CCAs).
  
  
  
  This was an analytical sectional study involving a review of secondary cervical cytology data collected from women living in the state of Maranhão, Brazil, in 2007-2012 and collected from the Cervical Cancer Information System (Sistema de Informação do Câncer do Colo do Útero - SISCOLO). The cervical screening results were classified according to the Brazilian Classification of Cervical Reporting (Nomenclatura Brasileira para Laudos Cervicais), an adaptation of the Bethesda System. The Municipal Human Development Index (MHDI) was used, which is an adaptation of the global HDI. The association between CCAs and MHDI was evaluated using the chi-squared test and odds ratios (ORs) with 95 % confidence intervals (95 % CI). The significance level used for all tests was 5 %.
  
  
  
  We analysed 1,363,689 examinations of women living in the state of Maranhão. CCAs were identified in 2.0 % of smears in municipalities with high MHDI, 2.2 % in those with medium or low MHDI and 4.1 % in those with very low MHDI. In addition, potentially malignant changes and suspected cervical cancer (HSIL+) were 40.0 % more frequent (0.3 %) in municipalities with medium or low MHDI and 3.6 times more frequent (0.8 %) in municipalities with very low MHDI compared to those with high MHDI (0.2 %).
  
  
  
  The association between MHDI and the occurrence of CCAs and HSIL+ shows that more developed areas with more effective health services have a lower prevalence of these lesions. To control cervical cancer, it is necessary to reduce social inequality and improve the availability of health services.
authors: Department of Medicine III, Federal University of Maranhão (Universidade Federal do Maranhão), Praça Gonçalves Dias, 21/2° andar, Centro, São Luís, MA, 65020-240, Brazil. jpfranca@uol.com.br.
authors: José De Ribamar
authors: JR
authors: Pinho-França
authors: Department of Medicine III, Federal University of Maranhão (Universidade Federal do Maranhão), Praça Gonçalves Dias, 21/2° andar, Centro, São Luís, MA, 65020-240, Brazil.
authors: Maria Bethânia Da Costa
authors: MBDC
authors: Chein
authors: Graduate Program in Oncology, National Cancer Institute (Instituto Nacional de Câncer), Rua André Cavalcanti, 37/2° andar, Centro, Rio de Janeiro, 20231-050, Brazil.
authors: Luiz Claudio Santos
authors: LCS
authors: Thuler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil / Q000453:epidemiology; D002584:Cervix Uteri / Q000002:abnormalities* / Q000166:cytology*; D002648:Child; D055088:Early Detection of Cancer / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000453:epidemiology
keywords: Brazil; Cancer precursor lesions; Cervical cancer; Cytological Abnormalities; Health status disparities; Human development index