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Cuervo LG, Villamizar CJ, Cuervo D, Zapata P, Ospina MB, Valencia SM, Polo A, Suárez Á, Bula MO, Miranda JJ, Millan G, Cuervo DE, Owens NJ, Piquero F, Hatcher-Roberts J, Paredes GD, Navarro MF, Minotta IL, Palta C, Martínez-Herrera E, Jaramillo C. Improving accessibility to radiotherapy services in Cali, Colombia: cross-sectional equity analyses using open data and big data travel times from 2020. Int J Equity Health 2024; 23:161. [PMID: 39148041 PMCID: PMC11325712 DOI: 10.1186/s12939-024-02211-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 06/12/2024] [Indexed: 08/17/2024] Open
Abstract
In this study, we evaluated and forecasted the cumulative opportunities for residents to access radiotherapy services in Cali, Colombia, while accounting for traffic congestion, using a new people-centred methodology with an equity focus. Furthermore, we identified 1-2 optimal locations where new services would maximise accessibility. We utilised open data and publicly available big data. Cali is one of South America's cities most impacted by traffic congestion. METHODOLOGY Using a people-centred approach, we tested a web-based digital platform developed through an iterative participatory design. The platform integrates open data, including the location of radiotherapy services, the disaggregated sociodemographic microdata for the population and places of residence, and big data for travel times from Google Distance Matrix API. We used genetic algorithms to identify optimal locations for new services. We predicted accessibility cumulative opportunities (ACO) for traffic ranging from peak congestion to free-flow conditions with hourly assessments for 6-12 July 2020 and 23-29 November 2020. The interactive digital platform is openly available. PRIMARY AND SECONDARY OUTCOMES We present descriptive statistics and population distribution heatmaps based on 20-min accessibility cumulative opportunities (ACO) isochrones for car journeys. There is no set national or international standard for these travel time thresholds. Most key informants found the 20-min threshold reasonable. These isochrones connect the population-weighted centroid of the traffic analysis zone at the place of residence to the corresponding zone of the radiotherapy service with the shortest travel time under varying traffic conditions ranging from free-flow to peak-traffic congestion levels. Additionally, we conducted a time-series bivariate analysis to assess geographical accessibility based on economic stratum. We identify 1-2 optimal locations where new services would maximize the 20-min ACO during peak-traffic congestion. RESULTS Traffic congestion significantly diminished accessibility to radiotherapy services, particularly affecting vulnerable populations. For instance, urban 20-min ACO by car dropped from 91% of Cali's urban population within a 20-min journey to the service during free-flow traffic to 31% during peak traffic for the week of 6-12 July 2020. Percentages represent the population within a 20-min journey by car from their residence to a radiotherapy service. Specific ethnic groups, individuals with lower educational attainment, and residents on the outskirts of Cali experienced disproportionate effects, with accessibility decreasing to 11% during peak traffic compared to 81% during free-flow traffic for low-income households. We predict that strategically adding sufficient services in 1-2 locations in eastern Cali would notably enhance accessibility and reduce inequities. The recommended locations for new services remained consistent in both of our measurements.These findings underscore the significance of prioritising equity and comprehensive care in healthcare accessibility. They also offer a practical approach to optimising service locations to mitigate disparities. Expanding this approach to encompass other transportation modes, services, and cities, or updating measurements, is feasible and affordable. The new approach and data are particularly relevant for planning authorities and urban development actors.
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Affiliation(s)
- Luis Gabriel Cuervo
- Departamento de Pediatría, de Obstetricia y Ginecología y de Medicina Preventiva y Salud Pública. Facultad de Medicina - Edificio M, Universitat Autònoma de Barcelona, Campus Universitario UAB, 08193, Bellaterra, (Cerdanyola del Vallès) Cataluña, Spain.
- Academia Nacional de Medicina de Colombia, Cra. 7ª # 69-11, 110231, Bogotá, Colombia.
| | - Carmen Juliana Villamizar
- Johns Hopkins Bloomberg School of Public Health, Wolfe Street Building, W1015, Baltimore, MD, 21205, USA
| | - Daniel Cuervo
- IQuartil SAS, Cra 13A # 107A-47, 110111, Bogotá, Colombia
| | - Pablo Zapata
- IQuartil SAS, Cra 13A # 107A-47, 110111, Bogotá, Colombia
| | - Maria B Ospina
- Department of Public Health Sciences, Faculty of Health Sciences, Queen's University, Carruthers Hall 204, Kingston, ON, K7L 3N6, Canada
| | - Sara Marcela Valencia
- Universidad Nacional de Colombia, Ave Cra. 30 # 45-03, 111321, Bogotá, Colombia
- Facultad de Medicina, Universidad de Antioquia, Cra. 51D # 62-29, Medellín, Antioquia, 050010, Colombia
| | - Alfredo Polo
- Technical Cooperation and Capacity Development, City Cancer Challenge Foundation, 9 Rue du Commerce, Geneva, 1204, Switzerland
| | - Ángela Suárez
- Johns Hopkins Bloomberg School of Public Health, Wolfe Street Building, W1015, Baltimore, MD, 21205, USA
| | - Maria O Bula
- Independent Researcher, 110221, Bogotá, Colombia
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 445 - Miraflores, 15074, Lima, Peru
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Gynna Millan
- Universidad del Valle, Cali, Valle del Cauca, 760032, Colombia
| | - Diana Elizabeth Cuervo
- Junta Nacional de Calificación de Invalidez [National Disability Board of Colombia], 110111, Bogotá, Colombia
| | - Nancy J Owens
- Independent Content and Communications Consultant, Fairfax, VA, 22032, USA
| | - Felipe Piquero
- Patient Advocate and Author of an Autopathography, 110231, Bogotá, Colombia
| | - Janet Hatcher-Roberts
- WHO Collaborating Centre for Knowledge Translation and Health Technology Assessment for Health Equity, Bruyère Research Institute, University of Ottawa, Ottawa, ON, K1N 5C8, Canada
| | - Gabriel Dario Paredes
- Independent Consultant On Emergency Medicine and Humanitarian Response, 110111, Bogotá, Colombia
| | | | | | - Carmen Palta
- ProPacífico, Calle 35 Norte #6A Bis - 100, 760046, Cali, Valle del Cauca, Colombia
| | - Eliana Martínez-Herrera
- National Faculty of Public Health, Universidad de Antioquia, Cl. 62 #52-59, La Candelaria, 050010, Medellín, Antioquia, Colombia
- JHU-UPF Public Policy Center, Departament de Ciències Polítiques I Socials, Universitat Pompeu Fabra (UPF), Barcelona School of Management (UPF-BSM), Barcelona, Cataluña, Spain
| | - Ciro Jaramillo
- School of Civil and Geomatic Engineering of the Universidad del Valle, Cali, Valle del Cauca, 760032, Colombia
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Torres GF, Alarcón BA, Reyes-Sanchez JM, Castaño-Gamboa N, Buitrago G. Net costs of breast cancer in Colombia: a cost-of-illness study based on administrative claims databases. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2024; 22:54. [PMID: 38956674 PMCID: PMC11218325 DOI: 10.1186/s12962-024-00562-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 06/24/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Breast Cancer (BC) is associated with substantial costs of healthcare; however, real-world data regarding these costs in Colombia is scarce. The contributory regime provides healthcare services to formal workers and their dependents and covers almost half of the population in Colombia. This study aims to describe the net costs of healthcare in women with BC covered by the contributory regime in Colombia in 2019 from the perspective of the Colombian Health System. METHODS The main data source was the Capitation Sufficiency Database, an administrative database that contains patient-level data on consumption of services included in the National Formulary (PBS, in Spanish Plan de Beneficios en Salud). Data on consumption of services not included in the PBS (non-PBS) were calculated using aggregated data from MIPRES database. All direct costs incurred by prevalent cases of BC, from January 1 to December 31, 2019, were included in the analysis. The net costs of the disease were estimated by multiplying the marginal cost and the expected number of cases with BC by region and age group. Marginal costs were defined as the costs of services delivered to patients with BC after subtracting the expected costs of health services due to age, comorbidity burden or region of residence. To calculate these costs, we used Propensity Score Matching in the main analysis. All costs were expressed in 2019 international dollars. Productivity losses, transportation expenses, and caregiving costs were not included. RESULTS A total of 46,148 patients with BC were identified. Total net costs were $387 million (95% CI $377 to $396 million), 60% associated with non-PBS services. Marginal costs were $8,366 (95% Confidence Interval $8,170 to $8,573), with substantial variations between regions age groups (from $3,919 for older patients in the Amazonia region to $10,070 for younger patients in the Pacific region). The costs for PBS services were higher for ambulatory services and for patients who died during 2020. CONCLUSIONS BC imposes a substantial economic burden for the Colombian Health System with important variations in net costs between regions and age groups. Patients near death and ambulatory services were associated with higher costs of healthcare.
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Affiliation(s)
- Gabriel Fernando Torres
- Instituto de Investigaciones Clínicas, Universidad Nacional de Colombia, Carrera 45 # 26-85, Bogotá, 111321, Colombia.
| | | | | | | | - Giancarlo Buitrago
- Instituto de Investigaciones Clínicas, Universidad Nacional de Colombia, Carrera 45 # 26-85, Bogotá, 111321, Colombia
- Hospital Universitario Nacional, Calle 44 # 59-75, Bogotá, 111321, Colombia
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Rashdan O. Estimating the indirect economic burden of cancer in Jordan: a retrospective observational study. BMJ Open 2024; 14:e082025. [PMID: 38830736 PMCID: PMC11149137 DOI: 10.1136/bmjopen-2023-082025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 05/21/2024] [Indexed: 06/05/2024] Open
Abstract
OBJECTIVE The aim of this study is to estimate the indirect economic burden of 22 cancer types in Jordan using both the human capital approach (HCA) and the value of a statistical life year (VSLY) approach. Additionally, this study aims to forecast the burden of these cancers for the next 5 years while employing time series analysis. DESIGN Retrospective observational study with a time series analysis. PARTICIPANTS Disability adjusted life years records from the IHME Global Burden Disease estimates 2019 data. PRIMARY OUTCOME MEASURE Indirect economic burden of cancer in Jordan. RESULTS The mean total economic burden for all cancers is estimated to be $1.82 billion using HCA and $3.13 billion using VSLY approach. The cancers contributing most to the total burden are 'tracheal, bronchus and lung cancer' ($359.5 million HCA, $618.3 million VSLY), followed by 'colon and rectum cancer' ($300.6 million HCA, $517.1 million VSLY) and 'breast cancer' ($292.4 million HCA, $502.9 million VSLY). The indirect economic burden ranged from 1.4% to 2.1% of the gross domestic product (GDP) using the HCA, and from 2.3% to 3.6% of the GDP using the VSLY approach. The indirect economic burden is expected to reach 2.3 and 3.5 billion Intl$ by the year 2025 using the HCA and VSLY approach, respectively. CONCLUSION The indirect economic burden of cancer in Jordan amounted to 1.4%-3.6% of total GDP, with tracheal, bronchus and lung cancer; colon and rectum cancer; and breast cancer contributing to over 50% of the total burden. This will help set national cancer spending priorities following Jordan's economic modernisation vision with regard to maximising health economic outcomes.
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Affiliation(s)
- Omar Rashdan
- Faculty of Pharmacy, Middle East University, Amman, Jordan
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Okyere Asante PG, Owusu AY, Oppong JR, Amegah KE, Nketiah-Amponsah E. An assessment of the direct and indirect costs of breast cancer treatment in leading cancer hospitals in Ghana. PLoS One 2024; 19:e0301378. [PMID: 38771827 PMCID: PMC11108162 DOI: 10.1371/journal.pone.0301378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 03/14/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND In Ghana, breast cancer remains the most common cancer and the leading cause of cancer deaths among women. The cost of treating cancer is huge and poses a great challenge for patients, their families, and health care systems. While comprehensive studies have been conducted on the economic burden of cancers in developed economies such as the EU and the US, there are limited studies in Africa, and Ghana, in particular. This study quantitatively assessed Ghana's direct and indirect costs of breast cancer treatment. METHODS Primary data were collected using a questionnaire administered to 217 breast cancer patients at the Korle-Bu and Komfo Anokye Teaching Hospitals, Ghana's two leading hospitals, and Sweden Ghana Medical Centre. Direct and indirect costs were computed using the Cost-of-Illness Approach. Quantitative analysis was done using multivariate linear regression. RESULTS The findings showed that the breast cancer patients studied paid a median amount of Ghana cedis (GHC) 31,021.0 (IQR; 25,262.5-42,147.0), approximating USD 5,500.2 (IQR: 4,477.0-7,469.2 USD) for their treatment within one year of active treatment in 2019. About 61.9% (95% CI: 61.8-62.0%) of this cost was direct cost, while the remaining 38.1% (95% CI: 38.0-38.1%) was indirect cost. Patients who sought care from public facilities for breast cancer paid a median amount of GHC 29,606.3 (USD 5,249.3), while those who sought care from private facilities paid GHC 55,071.2 (USD 9,744.4). Findings from the multivariate linear regression indicate that being married/cohabiting, divorced/separated and having tertiary level education predicted higher cost of breast cancer treatment while patients on retirement and patients in the middle stage (Stage II) of breast cancer diagnoses were associated with lower cost of breast cancer treatment. CONCLUSIONS The cost of breast cancer treatment poses a significant burden on patients and their families. There is a need for increased public funding for breast cancer treatment to reduce the huge economic burden its treatment poses for patients and their families.
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Affiliation(s)
- Patience Gyamenah Okyere Asante
- Institute of Statistical, Social and Economic Research (ISSER), College of Humanities, University of Ghana, Legon, Accra, Ghana
| | - Adobea Yaa Owusu
- Institute of Statistical, Social and Economic Research (ISSER), College of Humanities, University of Ghana, Legon, Accra, Ghana
| | - Joseph Ransford Oppong
- Department of Geography, University of North Texas, Denton, Texas, United States of America
| | - Kingsley E. Amegah
- Department of Data Science and Economic Policy, University of Cape Coast, School of Economics, Cape Coast, Ghana
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Çeli K Y, Çeli K SŞ, Sarıköse S, Arslan HN. Evaluation of financial toxicity and associated factors in female patients with breast cancer: a systematic review and meta-analysis. Support Care Cancer 2023; 31:691. [PMID: 37953376 DOI: 10.1007/s00520-023-08172-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 11/07/2023] [Indexed: 11/14/2023]
Abstract
PURPOSE These systematic review and meta-analysis were conducted to discuss the financial toxicity (FT) level among breast cancer (BC) patients and the associated demographic and economic factors. METHODS A systematic review and meta-analysis of single means were used by following the Joanna Briggs Institute guidelines and PRISMA guidance. Untransformed means (MRAW) were used to estimate the confidence interval for individual studies, while I2 and tau2 statistics were used to examine heterogeneity among pooled studies. Electronic databases were PubMed, CINAHL, Web of Science, Scopus, Cochrane Library, Ovid MEDLINE(R), Science Direct, and Turkish databases were used to find relevant studies published in the last 15 years (between 2008 and 2023). RESULTS A total of 50 studies were reviewed in the systematic review, and 11 were included in the overall and subgroup meta-analyses. The majority of reviewed studies were from the USA (38 studies), while there were four studies from China and eight studies from other countries having different types of health systems. The overall estimated FT level based on 11 pooled studies was 23.19, meaning mild level FT in the range of four categories (no FT score > 25, mild FT score 14-25, moderate FT score 1-13, and severe FT score equal to 0), with a 95% CI of 20.66-25.72. The results of subgroup meta-analyses showed that the estimated FT levels were higher among those patients who were single, with lower education levels, stage 3 patients, younger, lower income, unemployed, and living in other countries compared to those who were married, more educated, and stages 1 and 2 patients, more aged, more income, employed, and patients in the USA. CONCLUSION The cost-effectiveness of the treatment strategies of BC depends on the continuity of care. However, FT is one of the leading factors causing BC patients to use the required care irregularly, and it has a negative effect on adherence to treatment. So, removing the economic barriers by taking appropriate measures to decrease FT will increase the efficiency of already allocated resources to BC treatments and improve the health outcomes of BC patients.
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Affiliation(s)
- Yusuf Çeli K
- Faculty of Health Sciences, Department of Health Management, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Sevilay Şenol Çeli K
- Koç University School of Nursing, Koç University Health Sciences Campus, Istanbul, Turkey
| | - Seda Sarıköse
- Koç University School of Nursing, Koç University Health Sciences Campus, Istanbul, Turkey.
| | - Hande Nur Arslan
- Koç University School of Nursing, Koç University Health Sciences Campus, Istanbul, Turkey
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Mosquera I, Barajas CB, Zhang L, Lucas E, Benitez Majano S, Maza M, Luciani S, Basu P, Carvalho AL. Assessment of organization of cervical and breast cancer screening programmes in the Latin American and the Caribbean states: The CanScreen5 framework. Cancer Med 2023; 12:19935-19948. [PMID: 37768035 PMCID: PMC10587918 DOI: 10.1002/cam4.6492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 07/21/2023] [Accepted: 08/23/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND In the Community of Latin American and Caribbean States (CELAC), breast cancer and cervical cancer are the first and third causes of cancer death among females. The objectives are to assess the characteristics of the cervical and breast cancer screening programmes in CELAC, their level of organization, and the association of screening organization and coverage of essential health services. METHODS Representatives of the Ministries of Health of 33 countries were invited to the CanScreen5 project. Twenty-seven countries participated in a "Train The Trainers" programme on cancer screening, and 26 submitted data using standardized questionnaires. Data were discussed and validated. The level of organization of the screening programmes was examined adapting the list of essential elements of organized screening programmes identified in a recently published IARC study. RESULTS Twenty-one countries reported a screening programme for cervical cancer and 15 for breast cancer. For cervical cancer, 14 countries dedicated budget for screening (66.7%), and women had to pay in 3 countries for screening (14.3%), 9 for diagnosis (42.9%) and 8 for treatment (38.1%). Only 4 countries had a system to invite women individually (19.0%). For breast cancer, 8 countries dedicated budget for screening (53.3%), and women had to pay for screening in 3 countries (20.0%), diagnosis in 7 (46.7%) and treatment in 6 (40.0%). One country (6.7%) invited women individually. There was variability in the level of organization of both cancer screening programmes. The level of organization of cervical cancer screening and coverage of essential health services were correlated. CONCLUSION Large gaps were identified in the organization of cervical and breast cancer screening services. CELAC governments need pragmatic public health policies and strengthened health systems. They should guarantee sustainable funding, and universal access to cancer diagnosis and treatment. Moreover, countries should enhance their health information system and ensure adequate monitoring and evaluation.
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Affiliation(s)
- Isabel Mosquera
- Early Detection, Prevention & Infections BranchInternational Agency for Research on CancerLyonFrance
| | | | - Li Zhang
- Early Detection, Prevention & Infections BranchInternational Agency for Research on CancerLyonFrance
| | - Eric Lucas
- Early Detection, Prevention & Infections BranchInternational Agency for Research on CancerLyonFrance
| | - Sara Benitez Majano
- Pan American Health OrganizationWashingtonDCUSA
- Inequalities in Cancer Outcomes NetworkLondon School of Hygiene and Tropical MedicineLondonUK
| | | | | | - Partha Basu
- Early Detection, Prevention & Infections BranchInternational Agency for Research on CancerLyonFrance
| | - Andre L. Carvalho
- Early Detection, Prevention & Infections BranchInternational Agency for Research on CancerLyonFrance
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Mosegui GBG, Vianna CMDM, Antoñanzas Villar F, Rodrigues MPDS. Perda de Produtividade Atribuída a Neoplasias na América do Sul. REVISTA BRASILEIRA DE CANCEROLOGIA 2023. [DOI: 10.32635/2176-9745.rbc.2023v69n1.3289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
Introdução: A carga da doença tem sido empregada em estimativas do impacto das neoplasias, mas a perda de produtividade em razão dessas enfermidades ainda não foi tão explorada. Objetivo: Estimar os anos de vida produtiva perdidos (AVPP) e a perda de produtividade por conta da mortalidade prematura relacionada ao câncer em países da América do Sul em 2019. Método: Dados de mortalidade disponíveis no Global Burden of Disease (GBD) Study 2019 foram usados para estimar a carga de doença atribuível a neoplasias. A perda de produtividade em termos monetários foi calculada usando um proxy da abordagem do capital humano (ACH). Os cálculos foram realizados por sexo, nas faixas etárias de trabalho. Resultados: O total de óbitos foi de 192.240 e o de AVPP, 2.463.155. A perda total de produtividade permanente foi de US$ 4,4 bilhões e US$ 9,4 bilhões em purchasing power parity (PPP) – 0,13% do produto interno bruto (PIB) da região. O custo total por morte foi de US$ 23.617. Houve diferenças significativas entre os países, mas a variação dos cenários mostra robustez das estimativas. Conclusão: O câncer impõe um ônus econômico significativo à América do Sul tanto em termos de saúde quanto de produtividade. Sua caracterização pode subsidiar os governos na alocação de recursos destinados ao planejamento de políticas e execução de intervenções de saúde.
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Saes-Silva E, Vieira YP, Viero VDSF, Rocha JQS, Saes MDO. [Trend of inequalities in the performance of mammography in Brazilian capitals in the last ten years]. CIENCIA & SAUDE COLETIVA 2023; 28:397-404. [PMID: 36651395 DOI: 10.1590/1413-81232023282.07742022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 07/26/2022] [Indexed: 01/18/2023] Open
Abstract
The objective was to verify the trend of inequality in the realization of mammography exam according to the possession of health insurance plan and schooling from data from the period 2011 to 2020 of VIGITEL. Population-based study with data from the Surveillance System of Risk and Protection Factors for Chronic Diseases by Telephone Survey (VIGITEL) between 2011 and 2020. Outcome: mammography exam in the last 2 years in women aged 50 to 69 years. The magnitude of inequalities of outcome in relation to exposures (health insurance plan and education) was estimated using two indices: inequality slope index (SII) and concentration index (CIX). The prevalence of mammography exam (2011-2020) increased from 74,4% to 78,0%, with a stable trend. The prevalence of those with health insurance plan were 85,7% and 86,4%, and without 63.4% and 71.2%, with an increasing trend. According to education, women with 0-8 years of schooling the prevalence increased from 68,2% to 72,6%, 9-11 years from 80,4% to 80,0% (decreasing trend), 12 years or more 88,0% to 86,6% (decreasing trend). As for the absolute (SII) and relative (CIX) inequality indices of schooling and health insurance plan show that there is a decrease in inequality over the last 10 years.
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Affiliation(s)
- Elizabet Saes-Silva
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Rio Grande. R. Visconde de Paranaguá 102. 96203-900 Rio Grande RS Brasil.
| | - Yohana Pereira Vieira
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Rio Grande. R. Visconde de Paranaguá 102. 96203-900 Rio Grande RS Brasil.
| | - Vanise Dos Santos Ferreira Viero
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Rio Grande. R. Visconde de Paranaguá 102. 96203-900 Rio Grande RS Brasil.
| | - Juliana Quadros Santos Rocha
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Rio Grande. R. Visconde de Paranaguá 102. 96203-900 Rio Grande RS Brasil.
| | - Mirelle de Oliveira Saes
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Rio Grande. R. Visconde de Paranaguá 102. 96203-900 Rio Grande RS Brasil.
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Streamlining breast cancer and colorectal cancer biosimilar regulations to improve treatment access in Latin America: an expert panel perspective. Lancet Oncol 2022; 23:e348-e358. [DOI: 10.1016/s1470-2045(22)00121-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/11/2022] [Accepted: 02/17/2022] [Indexed: 11/20/2022]
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