Influence of Public Oral Health Services and Socioeconomic Indicators on the Frequency of Hospitalization and Deaths due to Oral Cancer in Brazil, between 2002-2017.

Aldelany R Freire,Elza C F De Araújo,Yuri W Cavalcanti,Edson H G De Lucena,Deborah E W G Freire

doi:10.3390/ijerph18010238

Abstract

Background: Oral cancer is a frequent neoplasm worldwide, and socioeconomic factors and access to health services may be associated with its risk. Aim: To analyze effect of socioeconomic variables and the influence of public oral health services availability on the frequency of new hospitalized cases and mortality of oral cancer in Brazil. Materials and Methods: This observational study analyzed all Brazilian cities with at least one hospitalized case of oral cancer in the National Cancer Institute database (2002–2017). For each city were collected: population size, Municipal Human Development Index (MHDI), Gini Coefficient, oral health coverage in primary care, number of Dental Specialized Centers (DSC) and absolute frequency of deaths after one year of the first treatment. The risk ratio was determined by COX regression, and the effect of the predictor variables on the incidence of cases was verified by the Hazard Ratio measure. Poisson regression was used to determine factors associated with higher mortality frequency. Results: Cities above 50,000 inhabitants, with high or very high MHDI, more unequal (Gini > 0.4), with less oral health coverage in primary care (<50%) and without DSC had a greater accumulated risk of having 1 or more cases (p < 0.001). Higher frequency of deaths was also associated with higher population size, higher MHDI, higher Gini and lower oral health coverage in primary care (p < 0.001). Conclusions: The number hospitalization and deaths due to oral cancer in Brazil was influenced by the cities’ population size, the population’s socioeconomic status and the availability of public dental services.

Highlights

Oral cancer represents one of the most frequent neoplasms worldwide, with greater prominence in developing countries, the incidence varies between different regions [1,2]
Individuals with worse socioeconomic status are more exposed to behavioral risk factors and have limited access to health services throughout their lives, which contributes to less prevention and late diagnosis of oral cancer [9,10]
There is an increase in the average number of hospitalized cases of oral cancer in Brazil in the mid-2000s, followed by stability and a drop in the last years analyzed

Summary

Introduction

Oral cancer represents one of the most frequent neoplasms worldwide, with greater prominence in developing countries, the incidence varies between different regions [1,2]. In Brazil, 10.70 new cases are estimated for every 100,000 men and 3.71 for every 100,000 women, in each year of the 2020–2022 triennium [3] According to this estimate, the disease will represent the fifth most common type of cancer among men, and the thirteenth among women by 2022 [3]. Smoking and alcoholism are considered the main risk factors for oral cancer [4,5]. Other aspects such as human papillomavirus infection, solar radiation and genetics are part of its complex etiology [2,5,6]. Individuals with worse socioeconomic status are more exposed to behavioral risk factors (such as tobacco and alcohol consumption) and have limited access to health services throughout their lives, which contributes to less prevention and late diagnosis of oral cancer [9,10]

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