The impact of inequalities and health expenditure on mortality due to oral and oropharyngeal cancer in Brazil

Amanda Ramos Da Cunha,Fernando Neves Hugo,José Leopoldo Ferreira Antunes,Alessandro Bigoni

doi:10.1038/s41598-021-92207-x

Amanda Ramos Da Cunha, Fernando Neves Hugo + Show 2 more

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https://doi.org/10.1038/s41598-021-92207-x

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Abstract

This study aims to assess the magnitude and trend of mortality rates due to oral (OC) and oropharyngeal cancer (OPC) in the 133 Intermediate Geographic Regions (IGR) of Brazil between 1996 and 2018 and to analyze its association with sociodemographic variables and provision of health services. It also aims to compare the trend of mortality from neoplasms that have been reported as associated with HPV (OPC) with the trend of neoplasms that have been reported as not associated with HPV (OC). We obtained mortality data from the Mortality Information System in Brazil and analyzed the trends using the Prais-Winsten method. Then, we assessed the relationship between mortality trends and socioeconomic, health spending, and health services provision variables. The median of the annual percent change of the country’s mortality rates was 0.63% for OC and 0.83% for OPC. Trends in mortality in the IGRs correlated significantly with the Human Development Index and government expenditure on ambulatory health care and hospitalizations. Mortality from both types of cancer decreased in those IGR in which the government spent more on health and in the more socioeconomically developed ones. This study found no epidemiological indication that HPV plays the leading etiological factor in OPC in Brazil.

Highlights

The incidence and mortality from oral and oropharyngeal cancer (OC and OPC) is a global concern
As proposed by different previous s tudies[19,20], this classification aimed to compare the trend of mortality from neoplasms that have been reported as associated with Human Papillomavirus (HPV) (OPC) with the trend of mortality from neoplasms that have been reported as not associated with HPV (OC)
This study assessed the trend of mortality from OC and OPC in the last two decades in Brazil and the relationship between these trends and the region’s human development, provision of health services, and governmental health expenditures

Summary

Introduction

The incidence and mortality from oral and oropharyngeal cancer (OC and OPC) is a global concern. The authors identified an increasing pattern in OPC incidence, contrasting with a decreasing (or stable) trend in OC incidence in high-income countries This difference was attributed to the growing role of the HPV virus in oropharyngeal cancer’s etiology—which. Considering mortality, HPV-related neoplasms have a better prognosis (are less lethal and favor greater survival) than those not related to H PV15,16 Due to this difference, the analysis of mortality trends may provide clues about the etiological patterns of these diseases. If a cancer patient lives in a small city without a hospital, he/she is likely to be referred for hospital treatment in a more structured city close to his local residence, which serves as a reference for more complex urban functions for that region This characteristic makes IGR an opportune territorial division to study the determinants of mortality from OC and OPC, identifying which factors are associated with more favorable regional outcomes. To this date, no study examined if mortality due to OPC and OC varies by IGR

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