Impacto de fatores sociodemográficos e estratégias de rastreamento, diagnóstico e tratamento na mortalidade por câncer colorretal no Brasil: um estudo ecológico de 20 anos
Brazil, colorectal neoplasms, mortality, survival analysis, epidemiology
Colorectal cancer (CRC) caused 261,060 deaths in Brazil over a 20-year period, with a tendency to increase over time. This study aimed to verify the sociodemographic factors predicting higher mortality from CRC and worse survival. Moreover, we aimed to verify whether the performance of screening, diagnostic, and treatment procedures impacted mortality reduction. This observational ecological study on CRC mortality was conducted in Brazil between 2000 and 2019 using a secondary database. The adjustment variable was age, which was used to calculate the age-standardized mortality rate (ASMR). The exposure variables were the number of deaths and ASMR. The outcome variables were age–period–cohort; racial classification; marital status; geographic region; and screening, diagnostic, and treatment procedures. Age–period–cohort analysis was applied. One-way analysis of variance and the Kruskal–Wallis test with post hoc tests were used to determine differences in racial classification, marital status, and geographic region. Multinomial logistic regression was used to verify the interaction between the sociodemographic factors. Survival analysis included Kaplan–Meier and Cox regression analyses. Multivariate linear regression was used to verify the prediction using screening, diagnostic, and treatment procedures. In Brazil, mortality from CRC increased after the age of 45 years. The highest adjusted mortality rates were found among white individuals (9.16 [7.14–10.93]) and residents of the South (9.5±0.52; p<0.05). Single, married, and widowed individuals from the North and Northeast had a higher risk of death than those legally separated from the South (p<0.05). Lower survival rates were observed in brown and legally separated individuals and residents from the North (p<0.05). Colonoscopy, first line chemotherapy, and abdominal rectosigmoidectomy were associated with increased mortality (p<0.05). Previous- and second-line chemotherapy and abdominoperineal rectosigmoidectomy were associated with decreased mortality (p<0.05). Regional disparities in sociodemographic factors and procedures can serve as guidelines for the adaptation of public health policies.