1
|
Fantin R, Sierra MS, Vaccarella S, Herrero R, Barboza-Solís C. Social gradient and rural-urban disparities in cancer mortality in Costa Rica. Cancer Epidemiol 2024; 91:102604. [PMID: 38941875 PMCID: PMC11246819 DOI: 10.1016/j.canep.2024.102604] [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: 01/19/2024] [Revised: 06/14/2024] [Accepted: 06/19/2024] [Indexed: 06/30/2024]
Abstract
INTRODUCTION Data on social inequalities in cancer mortality are sparse, especially in low- and middle-income countries. We aimed to analyze the socioeconomic inequalities in cancer mortality in Costa Rica between 2010 and 2018. METHODS We linked 9-years of data from the National Electoral Rolls, National Birth Index and National Death Index to classify deaths due to cancer and socioeconomic characteristics of the district of residence, as measured by levels of urbanicity and wealth. We analyzed the fifteen most frequent cancer sites in Costa Rica among the 2.7 million inhabitants aged 20 years and older. We used a parametric survival model based on a Gompertz distribution. RESULTS Compared to urban areas, mixed and rural area residents had lower mortality from pancreas, lung, breast, prostate, kidney, and bladder cancers, and higher mortality from stomach cancer. Mortality from stomach, lung and cervical cancer was higher, and mortality from colorectal cancer, non-Hodgkin lymphoma and leukemia was lower in the most disadvantaged districts, compared to the wealthiest ones. CONCLUSION We observed marked disparities in cancer mortality in Costa Rica in particular from infection- and lifestyle- related cancers. There are important opportunities to reduce disparities in cancer mortality by targeting cancer prevention, early detection and opportune treatment, mainly in urban and disadvantaged districts.
Collapse
Affiliation(s)
- Romain Fantin
- Agencia Costarricense de Investigaciones Biomédicas, Fundación INCIENSA, San José, Costa Rica; Centro Centroamericano de Población, Universidad de Costa Rica, Costa Rica.
| | - Mónica S Sierra
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | | | - Rolando Herrero
- Agencia Costarricense de Investigaciones Biomédicas, Fundación INCIENSA, San José, Costa Rica
| | | |
Collapse
|
2
|
Nicolis O, De Los Angeles D, Taramasco C. A contemporary review of breast cancer risk factors and the role of artificial intelligence. Front Oncol 2024; 14:1356014. [PMID: 38699635 PMCID: PMC11063273 DOI: 10.3389/fonc.2024.1356014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/25/2024] [Indexed: 05/05/2024] Open
Abstract
Background Breast cancer continues to be a significant global health issue, necessitating advancements in prevention and early detection strategies. This review aims to assess and synthesize research conducted from 2020 to the present, focusing on breast cancer risk factors, including genetic, lifestyle, and environmental aspects, as well as the innovative role of artificial intelligence (AI) in prediction and diagnostics. Methods A comprehensive literature search, covering studies from 2020 to the present, was conducted to evaluate the diversity of breast cancer risk factors and the latest advances in Artificial Intelligence (AI) in this field. The review prioritized high-quality peer-reviewed research articles and meta-analyses. Results Our analysis reveals a complex interplay of genetic, lifestyle, and environmental risk factors for breast cancer, with significant variability across different populations. Furthermore, AI has emerged as a promising tool in enhancing the accuracy of breast cancer risk prediction and the personalization of prevention strategies. Conclusion The review highlights the necessity for personalized breast cancer prevention and detection approaches that account for individual risk factor profiles. It underscores the potential of AI to revolutionize these strategies, offering clear recommendations for future research directions and clinical practice improvements.
Collapse
Affiliation(s)
- Orietta Nicolis
- Engineering Faculty, Universidad Andres Bello, Viña del Mar, Chile
- Centro para la Prevención y Control del Cáncer (CECAN), Santiago, Chile
| | - Denisse De Los Angeles
- Engineering Faculty, Universidad Andres Bello, Viña del Mar, Chile
- Centro para la Prevención y Control del Cáncer (CECAN), Santiago, Chile
| | - Carla Taramasco
- Engineering Faculty, Universidad Andres Bello, Viña del Mar, Chile
- Centro para la Prevención y Control del Cáncer (CECAN), Santiago, Chile
| |
Collapse
|
3
|
Barboza-Solis C, Barahona-Cubillo J, Fantin R. Health inequalities in the geographic distribution of dental practitioners in Costa Rica: An ecological study. Community Dent Oral Epidemiol 2024; 52:39-46. [PMID: 37515401 DOI: 10.1111/cdoe.12899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023]
Abstract
OBJECTIVE The uneven distribution of dental health services in a territory can cause an imbalance in accessibility, increasing health inequalities. This study aimed to describe the geographical distribution of dental health practitioners according to urbanicity and area-level socio-economic status in Costa Rica. METHODS A National Dentist Survey was developed to identify employment status, number of working hours, address and list of the working clinics. Data was completed using information from the national College of Surgeons, including all Costa Rican dentists. The Minimal Geographic Units (MGU) allowed for aggregating the population's individual level socio-economic position. Local Potential Accessibility (LPA) calculated the density of full-time hour's equivalents around each MGU using floating sectors. Clinics were geocoded using Geographic Information Systems, creating 2853 clinical points. Distance between each MGU and the nearest accessible clinics considering full-time working hours equivalents was estimated. MGU were divided into six categories: 'No accessibility', 'Very low accessibility', 'Low accessibility', 'Good accessibility' 'High accessibility' and 'Very high accessibility'. RESULTS Mean national LPA was 6.5 full-time equivalents per 10 000 inhabitants, 3.4% of the Costa Rican population had no access to dentist; 12.9% had very low accessibility, 22.7% had low accessibility, 35.0% had good accessibility, 16.2% had high accessibility, and 9.8% had very high accessibility. Overall, 39% of the population has a rather low accessibility. LPA was higher in urban districts compared to rural districts and in wealthiest districts compared to most disadvantaged districts. Within districts, after adjustment for district's characteristics, LPA was higher in urban MGU compared to rural MGU and in wealthiest MGU compared to most disadvantaged MGU. CONCLUSIONS This study found that despite having a high number of dentists, their numbers are small in many areas, increasing inequalities in access to health care. The dentist's free establishment, where they can decide to provide private services within a community, creates zones with very high densities, in particular in the wealthiest urban areas, and others with very low densities, in particular the poorest rural areas. The lack of territorial planning has been one of the reasons that has encouraged an imbalance in the availability of dental human resources. To achieve effective universal health coverage, public institutions should focus their efforts on improving access to dental services in underserved areas.
Collapse
Affiliation(s)
| | | | - Romain Fantin
- Centro Centroamericano de Población, Universidad de Costa Rica, San José, Costa Rica
- Facultad de Medicina, Universidad de Costa Rica, San José, Costa Rica
- Agencia Costarricense de Investigaciones Biomédicas, Fundación INCIENSA, San José, Costa Rica
| |
Collapse
|
4
|
Pizzato M, di Maso M, Collatuzzo G, Pelucchi C, Turati F, Negri E, La Vecchia C, Boffetta P, Alicandro G. Cancer mortality associated with low education in Italy. J Public Health (Oxf) 2023; 45:822-828. [PMID: 37681283 DOI: 10.1093/pubmed/fdad164] [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: 05/24/2023] [Revised: 07/25/2023] [Accepted: 08/15/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND This study provides a nationwide representative quantification of the impact of educational inequalities on cancer mortality in Italy. METHODS The study is based on prevalence data and mortality rate ratios according to levels of education obtained from the Italian 2011 census cohort, including >35 million individuals aged 30-74. We estimated the population attributable fraction (PAF) and the number of cancer deaths associated with low education (below university degree) in Italy by sex. RESULTS PAFs for low levels of education were 29.1% among men and 13.3% among women, corresponding to 22,271 cancer deaths associated with low education in men and 7456 in women in 2019. PAFs by cancer site in men were: 53.0% for upper aerodigestive tract (UADT), 44.6% for liver, 41.3% for stomach, 41.3% for lung, 37.0% for bladder, 18.5% for colorectal, 9.8% for prostate and 9.1% for pancreatic cancers. PAFs in women were: 44.5% for cervical, 36.1% for UADT, 34.9% for stomach and 13.9% for colorectal cancers. The cancer sites with the highest number of deaths associated with low education were lung among men (7902/22,271, 35.5%) and colorectum among women (780/7456, 10.5%). CONCLUSIONS About a quarter of cancer deaths in 2019 in Italy may be prevented by reducing the socioeconomic determinants that contribute to educational disparities in cancer mortality.
Collapse
Affiliation(s)
- Margherita Pizzato
- Department of Clinical Sciences and Community Health, University of Milan, 20133 Milano, Italy
| | - Matteo di Maso
- Department of Clinical Sciences and Community Health, University of Milan, 20133 Milano, Italy
| | - Giulia Collatuzzo
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Claudio Pelucchi
- Department of Clinical Sciences and Community Health, University of Milan, 20133 Milano, Italy
| | - Federica Turati
- Department of Clinical Sciences and Community Health, University of Milan, 20133 Milano, Italy
| | - Eva Negri
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, 20133 Milano, Italy
| | - Paolo Boffetta
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
- Stony Brook Cancer Center, Stony Brook University, 11794 Stony Brook, NY, USA
| | - Gianfranco Alicandro
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milano, Italy
- Cystic Fibrosis Centre, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy
| |
Collapse
|
5
|
Meneses-Urrea LA, Vaquero-Abellán M, Villegas Arenas D, Benachi Sandoval N, Hernández-Carrillo M, Molina-Recio G. Association between Cervical Cancer and Dietary Patterns in Colombia. Nutrients 2023; 15:4889. [PMID: 38068749 PMCID: PMC10707912 DOI: 10.3390/nu15234889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 12/18/2023] Open
Abstract
Cervical cancer is a global public health problem. It is the second leading cause of death among women of childbearing age worldwide. Several factors, including diet, have been shown to influence the risk of persistent HPV infection and tumor progression. This paper determines the relationship between dietary patterns and cervical cancer. It is an ecological study of multiple groups, based on two national sources: the High-Cost Account and the National Survey of Nutritional Situation of Colombia of 2015. The population consisted of 3472 women aged 35 to 64. The incidence of cervical cancer was used as the dependent variable while the independent variables included food consumption according to established patterns, area of residence, age, physical activity, and BMI, among other variables. The statistical analysis performed through associations between variables was evaluated by multiple linear regression using R2. 38.9% of the evaluated population belonged to the first quartile of wealth, and 76.5% resided in the municipal capital. The incidence of cervical cancer in Colombia was associated with being affiliated to a state-subsidized health regime and having diabetes mellitus. A conservative eating pattern, as well as belonging to a rural area, are evidenced as protective factors. These results invite the need to encourage public policies and promote healthy lifestyles.
Collapse
Affiliation(s)
- Luz Adriana Meneses-Urrea
- Research Group “Health Care (Recognized by Colciencias)”, Universidad Santiago de Cali, Cali 760001, Colombia; (L.A.M.-U.); (D.V.A.); (N.B.S.)
- Department of Nursing, Universidad Santiago de Cali, Cali 760001, Colombia
| | - Manuel Vaquero-Abellán
- IMIBIC GC12 Clinical and Epidemiological Research in Primary Care (GICEAP), 14014 Córdoba, Spain
- Department of Nursing, Pharmacology and Physiotherapy, University of Córdoba, 14014 Córdoba, Spain;
| | - Dolly Villegas Arenas
- Research Group “Health Care (Recognized by Colciencias)”, Universidad Santiago de Cali, Cali 760001, Colombia; (L.A.M.-U.); (D.V.A.); (N.B.S.)
- Department of Nursing, Universidad Santiago de Cali, Cali 760001, Colombia
| | - Narly Benachi Sandoval
- Research Group “Health Care (Recognized by Colciencias)”, Universidad Santiago de Cali, Cali 760001, Colombia; (L.A.M.-U.); (D.V.A.); (N.B.S.)
- CAP Casanova, Consorci d’Atenció Primària de Salut Barcelona Esquerra, 08036 Barcelona, Spain
| | - Mauricio Hernández-Carrillo
- Health Faculty, Universidad del Valle, Cali 760001, Colombia;
- Health Faculty, Escuela Nacional del Deporte, Cali 760001, Colombia
| | - Guillermo Molina-Recio
- Department of Nursing, Pharmacology and Physiotherapy, University of Córdoba, 14014 Córdoba, Spain;
- Lifestyles, Innovation and Health (GA-16), Maimonides Biomedical Research Institute of Córdoba (IMIBIC), 14014 Córdoba, Spain
| |
Collapse
|
6
|
Fantin R, Delpierre C, Barboza-Solís C. Health inequalities in cause-specific mortality in Costa Rica: a population-based cohort study. Rev Saude Publica 2023; 57:3. [PMID: 36820682 PMCID: PMC9933644 DOI: 10.11606/s1518-8787.2023057004331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/13/2022] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVE To analyze health inequalities in cause-specific mortality in Costa Rica from 2010 to 2018, observing the main causes for inequality in the country. METHODS The National Electoral Rolls were used to follow-up all Costa Rican adults aged 20 years or older from 2010 to 2018 (n = 2,739,733) in an ecological study. A parametric survival model based on the Gompertz distribution was performed and the event death was classified according to the ICD-10. RESULTS After adjustment for urbanicity, the poorest districts had a higher mortality than the wealthier districts for most causes of death except neoplasms, mental and behavioral disorders, and diseases of the nervous system. Urban districts showed significantly higher mortality than mixed and rural districts after adjustment for wealth for most causes except mental and behavioral disorders, diseases of the nervous system, and diseases of the respiratory system. Differences according to wealth were more frequent in women than men, whereas differences according to urbanicity were more frequent in men than in women. CONCLUSIONS The study's findings were consistent, but not fully similar, to the international literature.
Collapse
Affiliation(s)
- Romain Fantin
- Universidad de Costa RicaCentro Centroamericano de PoblaciónSan JoséCosta Rica Universidad de Costa Rica. Centro Centroamericano de Población. San José, Costa Rica.,Universidad de Costa RicaFacultad de MedicinaEscuela de Salud PúblicaSan JoséCosta Rica Universidad de Costa Rica. Facultad de Medicina. Escuela de Salud Pública. San José, Costa Rica,Universidad de Costa RicaFacultad de OdontologíaSan JoséCosta Rica Universidad de Costa Rica. Facultad de Odontología. San José, Costa Rica
| | - Cyrille Delpierre
- Inserm-University Toulouse III Paul SabatierCenter for Epidemiology and Research in Population healthToulouseFranceInserm-University Toulouse III Paul Sabatier. Center for Epidemiology and Research in Population health. Toulouse, France
| | - Cristina Barboza-Solís
- Universidad de Costa RicaFacultad de OdontologíaSan JoséCosta Rica Universidad de Costa Rica. Facultad de Odontología. San José, Costa Rica
| |
Collapse
|
7
|
Gallo Marin B, Zheng DX, Gamboa DM, Frech FS, Amaya A, Mulligan KM, Oliva R, Soto A, Kuhn H. Contextualization of skin cancer incidence rates across Costa Rican provinces. Int J Dermatol 2022; 61:e478-e480. [PMID: 34813092 PMCID: PMC9124717 DOI: 10.1111/ijd.16010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/23/2021] [Accepted: 11/11/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Benjamin Gallo Marin
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - David X. Zheng
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
| | | | - Fabio Stefano Frech
- Department of Dermatology, Miller School of Medicine, University of Miami, Miami, Florida, United States
| | - Andres Amaya
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - Kathleen M. Mulligan
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
| | - Rocío Oliva
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | | | - Helena Kuhn
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
| |
Collapse
|
8
|
Barboza Solís C, Reyes-Carmona J, Fantin R. Social inequality in incidence and mortality of malignant neoplasms of lip, oral cavity and pharynx: Is Costa Rica an international paradox? Community Dent Oral Epidemiol 2021; 50:243-250. [PMID: 34076287 DOI: 10.1111/cdoe.12658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 04/13/2021] [Accepted: 04/20/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Low socioeconomic position (SEP) has been associated with higher incidences and mortality of lip, oral cavity and pharynx (LOP) cancers in the vast majority of countries with available data. The origins of health inequalities in cancer are socioeconomic, although they vary by time and country. Evidence from Low-and Middle-income Countries (LMICs) remains scarce. This study aims to identify and describe socioeconomic inequalities in LOP cancers incidence and mortality in Costa Rica. The hypothesis tested is that people leaving in low-SEP districts in Costa Rica have greater incidence and mortality rates of lip, oral cavity and pharynx cancers. METHODS The 10th revision of the International Classification of Diseases (ICD-10) was used to define cancer sites. Data come from a national population-based Cancer Registry with 100% completeness to study incidence. Incidence rate included all new cases of LOP cancer diagnosed from January 1, 2011, and December 31, 2015, for a total of 2 798 517 individuals, 13 832 524 years of follow-up and 601 LOP cases. Mortality rate was extracted from the National Death Index, including 2 739 733 individuals, 23 950 240 person-years of follow-up and 586 LOP cancer deaths, from January 1, 2010, to December 31, 2018. The 2011 Census (with 94% of Costa Rican inhabitants) was used to characterize the urbanicity and wealth of 477 districts. Survival models were performed for both incidence and mortality, allowing to consider existing competitive risks. Cox models were used for incidence, and parametric survival models based on a Gompertz distribution for mortality. RESULTS The study found that people who lived in the most socioeconomically disadvantaged areas had lower probabilities of developing LOP cancers than people in the richest districts. The same pattern for mortality, however, was not significant. CONCLUSIONS The hypothesis that incidence and mortality of LOP cancers will show a positive social gradient was not confirmed in this study, contradicting the existing literature. This could be explained by the social distribution of risky health behaviours, more frequent in socially advantaged populations.
Collapse
Affiliation(s)
| | | | - Romain Fantin
- Centro Centroamericano de Población, Universidad de Costa Rica, San José, Costa Rica.,Escuela de Salud Pública, Facultad de Medicina, Universidad de Costa Rica, San José, Costa Rica.,Escuela de Medicina, Facultad de Medicina, Universidad de Costa Rica, San José, Costa Rica
| |
Collapse
|