Abstract
BackgroundAccess to mammograms, in common with other diagnostic procedures, is strongly conditioned by socioeconomic disparities. Which aspects of inequality affect the odds of undergoing a mammogram, and whether they are the same in different localities, are relevant issues related to the success of health policies.MethodsThis study analyzed data from the 2008 PNAD - Brazilian National Household Sample Survey (11.607 million women 40 years of age or older), on having had at least one mammogram over life for women 40 years of age or older in each of Brazil’s nine Metropolitan Regions (MR), according to socioeconomic position. The effects of income, schooling, health insurance and race in the different regions were investigated using multivariate logistical regression for each region individually, and for all MRs combined. The age-adjusted odds of a woman having had a mammogram according to race and stratified by two income strata (and two schooling strata) were also analyzed.ResultsHaving a higher income increases four to seven times a woman’s odds of having had at least one mammogram in all MRs except Curitiba. For schooling, the gradient, though less steep, is favorable to women with more years of study. Having health insurance increases two to three times the odds in all MRs. Multivariate analysis did not show differences due to race (except for the Fortaleza MR), but the stratified analysis by income and schooling shows effects of race in most MRs, with greater differences for women with higher socioeconomic status.ConclusionsThis study confirms that income and schooling, as well as having health insurance, are still important determinants of inequality in health service use in Brazil. Additionally, race also contributes to the odds of having had a mammogram. The point is not to isolate the effect of each factor, but to evaluate how their interrelations may exacerbate differences, generating patterns of cumulative adversity, a theme that is still little explored in Brazil. This is much more important when we consider that race has only recently started be included in analyses of health outcomes in Brazil.
Highlights
Access to mammograms, in common with other diagnostic procedures, is strongly conditioned by socioeconomic disparities
Our aim was to explore the effect of income, education and race in different metropolitan settings, seeking to identify if there is a pattern of inequity and, if so, if this pattern varies according to Metropolitan Region
We chose to limit the analysis to Metropolitan Regions (MR), where geographic barriers to access are less important, but which still enable us to evaluate the effects of macro-regional differences on the odds of undergoing a mammogram
Summary
In common with other diagnostic procedures, is strongly conditioned by socioeconomic disparities. Which aspects of inequality affect the odds of undergoing a mammogram, and whether they are the same in different localities, are relevant issues related to the success of health policies. Screening procedures, such as mammograms, are essential for early detection of breast cancer, the most common type of cancer among women in Brazil and other countries. The smallest administrative divisions in the country are municipalities, encompassing both urban and rural areas [6]. Brazil is both highly urbanized and highly unequal. These patterns of concentration are manifest in terms of income, gross domestic product, and availability of services
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have