Abstract
BackgroundOral cancer is a potentially fatal disease, especially when diagnosed in advanced stages. In Brazil, the primary health care (PHC) system is responsible for promoting oral health in order to prevent oral diseases. However, there is insufficient evidence to assess whether actions of the PHC system have some effect on the morbidity and mortality from oral cancer. The purpose of this study was to analyze the effect of PHC structure and work processes on the incidence and mortality rates of oral cancer after adjusting for contextual variables.MethodsAn ecological, longitudinal and analytical study was carried out. Data were obtained from different secondary data sources, including three surveys that were nationally representative of Brazilian PHC and carried out over the course of 10 years (2002–2012). Data were aggregated at the state level at different times. Oral cancer incidence and mortality rates, standardized by age and gender, served as the dependent variables. Covariables (sociodemographic, structure of basic health units, and work process in oral health) were entered in the regression models using a hierarchical approach based on a theoretical model. Analysis of mixed effects with random intercept model was also conducted (alpha = 5%).ResultsThe oral cancer incidence rate was positively association with the proportion of of adults over 60 years (β = 0.59; p = 0.010) and adult smokers (β = 0.29; p = 0.010). The oral cancer related mortality rate was positively associated with the proportion of of adults over 60 years (β = 0.24; p < 0.001) and the performance of preventative and diagnostic actions for oral cancer (β = 0.02; p = 0.002). Mortality was inversely associated with the coverage of primary care teams (β = −0.01; p < 0.006) and PHC financing (β = −0.52−9; p = 0.014).ConclusionsIn Brazil, the PHC structure and work processes have been shown to help reduce the mortality rate of oral cancer, but not the incidence rate of the disease. We recommend expanding investments in PHC in order to prevent oral cancer related deaths.
Highlights
Oral cancer is a potentially fatal disease, especially when diagnosed in advanced stages
We considered oral cancer all International Code of Diseases (ICD) codes comprised between C00 and C10
While incidence rates did not vary over time, mortality rates increased between 2003 and 2012 (Fig. 2)
Summary
Oral cancer is a potentially fatal disease, especially when diagnosed in advanced stages. There is insufficient evidence to assess whether actions of the PHC system have some effect on the morbidity and mortality from oral cancer. The purpose of this study was to analyze the effect of PHC structure and work processes on the incidence and mortality rates of oral cancer after adjusting for contextual variables. Head and neck cancers are currently the seventh most common malignancy worldwide, with more than 600,000 new cases diagnosed each year; oral cancer is responsible for approximately half of these cases [1]. The incidence of oral cancer is increasing; it is not evenly distributed globally [2]. Brazil in particular has a rising incidence rate, [3, 4] with a projection of 16,340 new cases in 2016 [5]. The oral cancer incidence is higher in men and increases with age [5, 6]
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