Ovarian cancer mortality: implications of income-inequality and availability of medical doctors in Brazil.

Abstract

e22520 Background: Ovarian cancer mortality varies by region and age group in Brazil. However, it is still unknown if socioeconomic inequalities may affect its outcome even if indirectly as it happens for other gynecologic neoplasms in the country. Methods: Ecological study conducted with secondary data from 2016-2018 to examine the relationship between income-inequality and the amount of doctors per inhabitant on ovarian cancer mortality in Brazil. All data were gathered from Brazil’s public health system. Mortality was analyzed by sex and age, which was standardized according to the World Health Organization’s population. Income-Inequality was measured using the Gini index, obtained from the United Nations Development Programme. The number of doctors was obtained from the Unified Health System and was also calculated as the rate per 100,000 inhabitants. Linear regression was performed using stepwise selection/backward elimination. Results: Despite income inequality as measured by the Gini index not having any statistically significant relationship with ovarian cancer mortality rates, we found that the amount of doctors per inhabitant was positively associated with ovarian cancer mortality rates (β 0.037, IC95% 0.028;0.045), whereas the amount of clinical oncologists (β-0.426, IC95% -0.805; -0.047) and higher income (β -0.004, IC95% -0.005; -0.003) were all negatively associated with those rates (p < 0.05), meaning that the higher those variables, the lower the mortality. Conclusions: Ovarian cancer mortality differs among federative units in Brazil. Higher mortality is associated with a greater amount of doctors per inhabitant, whereas lower mortality rates were found to be associated with higher income and more clinical oncologists available.