Effects of the high-inequality of income on the breast cancer mortality in Brazil

Francisco Winter Dos Santos Figueiredo,Fernando Adami

doi:10.1038/s41598-019-41012-8

Francisco Winter Dos Santos Figueiredo, Fernando Adami

Open Access

https://doi.org/10.1038/s41598-019-41012-8

Copy DOI

Journal: Scientific Reports	Publication Date: Mar 12, 2019
Citations: 7	License type: open-access

Affiliation: Faculdade de Medicina do ABC

Abstract

As well as breast cancer mortality, the income inequality in Brazil is different between Federative units, including between units of the same region. To assess the effects of the high-inequality of income on breast cancer mortality in Brazilian Federative Units, in the 2010 year. This is an ecologic study. Deaths from breast cancer in Brazilian women according to Federative units were obtained from the Department of Informatics of the Unified Health System. Mortality by breast cancer was estimated per 100,000 women and age-standardized by the direct method according to World Health Organization population. Income inequality was measured by the Gini index obtained from the United Nations Development Programme. The High-inequality of income was classified by the third tercile of the distribution from the Gini index of the Federative units. Univariate analysis was performed according to data normality. Linear regressions were performed by the stepwise backward method. The confidence level was 5%. Stata® (Stata Corp, LC) 11.0. was used. The High-inequality of income was associated with worse social and demographic indicators. The age-standardized breast cancer mortality was larger in the high-inequality of income Federative units. In the adjusted analysis, these Federative units presented a mean of 2 more deaths (ranging from the 0.4 to 3.7 deaths, r² = 0.79; p = 0.018) by breast cancer per 100,000 women when compared to the Federative units without high-inequality of income. In the Brazilian Federative units, the high-inequality of income was associated with age-standardized breast cancer mortality more.

Highlights

The Federative units with high-inequality of income (Gini ≥ 0.62) are the ones with the worst socioeconomic and development indicators. This is reflected by the lower rate of aging (average difference of −1.5 (CI 95% −0.3; −2.8); p = 0.01), highest percentage of poverty, greater proportion of women under the age of 18 and who have children and lower Human Development Index for longevity (average difference of −0.03 (CI 95% −0.003; −0.05; p = 0.02)) and Human Development Index to education (average difference of −0.05 (CI 95% −0.1; −0.01); p = 0.02) found in the Federative units where high-inequality of income is present (Table 2)
On the other hand, when we adjusted the age-standardized breast cancer mortality by aging index and HDI longevity – variables present after exclusion in the statistical model, we observed that Federative units with high-inequality of income show 2 more deaths by breast cancer when compared to Federative units with low/moderate income inequality (Fig. 2)
Analyzing the differences in mortality rates for breast cancer among Federative units with high-inequality of income compared to Federative units with low/moderate inequality of income, we found that higher mortality due to breast cancer where there is a high-inequality of income

Summary

Introduction

The objective was to analyze the effects of high-inequality of income on mortality for breast cancer in Brazilian federal units in 2010. In model 1, which analyzed the mean difference in age-standardized breast cancer mortality according to the high-inequality of income adjusted for income per capita, no statistically significant differences were observed (mean difference of −1.5 (CI 95% −3.8; 1.5); r2 = 0.38; p = 0.001).

Results

Conclusion