Social inequalities in male cancer in a metropolis in the Southeast region of Brazil

Ferreira, Maria do Carmo; Arroyave, Ivan; Barros, Marilisa Berti de Azevedo

doi:10.11606/s1518-8787.2023057004712

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Sumário

Original Article • Rev. Saúde Pública 57 • 2023 • https://doi.org/10.11606/s1518-8787.2023057004712 copy

Social inequalities in male cancer in a metropolis in the Southeast region of Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

To analyze inequalities in incidence, mortality, and estimated survival for neoplasms in men according to social vulnerability.

METHODS

Analysis of cases and deaths of all neoplasms and the five most common in men aged 30 years or older in the city of Campinas (SP), between 2010 and 2014, using data from the Population-Based Cancer Registry (RCBP) and the Mortality Information System (SIM). The areas of residence were grouped into five social vulnerability strata (SVS) using São Paulo Social Vulnerability Index. For each SVS, age-standardized incidence and mortality rates were calculated. A five-year survival proxy was calculated by complementing the ratio of the mortality rate to the incidence rate. Inequalities between strata were measured by the ratios between rates, the relative inequality index (RII) and the angular inequality index (AII).

RESULTS

RII revealed that the incidence of all neoplasms (0.66, 95%CI 0.62–0.69) and colorectal and lung cancers were lower among the most socially vulnerable, who presented a higher incidence of stomach and oral cavity cancer. Mortality rates for stomach, oral cavity, prostate and all types of cancer were higher in the most vulnerable segments, with no differences in mortality for colorectal and lung cancer. Survival was lower in the most social vulnerable stratum for all types of cancer studied. AII showed excess cases in the least vulnerable and deaths in the most vulnerable. Social inequalities were different depending on the tumor location and the indicator analyzed.

CONCLUSION

There is a trend of reversal of inequalities between incidence-mortality and incidence-survival, and the most social vulnerable segment presents lower survival rates for the types of cancer, pointing to the existence of inequality in access to early diagnosis and effective and timely treatment.

Men; Neoplasms, epidemiology; Survival; Mortality; Health Status Disparities; Socioeconomic Factors

Primary tumor location	Social vulnerability strata

	SVS 1 (least vulnerable)		SVS 2		SVS 3		SVS 4		SVS 5 (most vulnerable)

Incidence

	n	IR (95%CI)	n	IR (95%CI)	n	IR (95%CI)	n	IR (95%CI)	n	IR (95%CI)
All neoplasms^b	2,080	744.3 (711.5–777.4)	2,484	689.0 (661.3–716.6)	1,726	647.8 (617.0–678.6)	1,267	553.3 (522.1–584.6)	680	537.6 (495.1–580.1)
Prostate	619	225.9 (207.7–244.2)	761	210.5 (195.2–225.7)	546	211.2 (193.4–229.0)	431	201.4 (182.13–220.7)	244	223.2 (194.6–251.7)
Colorectal	276	99.0 (87.0–110.9)	311	87.9 (77.9–97.9)	196	73.7 (63.3–84.1)	113	47.7 (38.7–56.7)	51	36.8 (26.1–47.4)
Lung	135	47.1 (39.0–55.2)	197	52.6 (45.0–60.1)	105	40.4 (32.6–48.2)	98	44.6 (35.6–53.5)	47	39.2 (27.6–50.8)
Stomach	90	29.9 (23.5–36.3)	146	38.2 (31.8–44.5)	106	40.5 (32.8–48.3)	98	43.1 (34.4–51.8)	62	51.2 (37.9–64.5)
Oral cavity	93	34.3 (32.2–36.4)	115	33.7 (27.5–39.9)	118	44.0 (36.0–51.9)	107	44.4 (35.8–53.1)	66	43.6 (32.4–54.7)

	Mortality

	n	MR (95%CI)	n	MR (95%CI)	n	MR (95%CI)	n	MR (95%CI)	n	MR (95%CI)

All neoplasms^b	699	233.9 (216.0–251.8)	975	258.5 (241.9–275.1)	754	285.9 (265.3–306.4)	611	269.1 (247.4–291.0)	343	272.9 (242.6–303.2)
Prostate	85	25.3 (19.7–30.9)	102	23.6 (22.6–24.6)	63	24.2 (23.0–25.4)	63	30.1 (28.7–31.6)	39	38.5 (36.0–41.0)
Colorectal	81	27.2 (25.6–28.8)	123	33.0 (27.0–39.0)	83	31.2 (24.5–38.0)	50	22.4 (16.1–28.7)	24	18.9 (11.1–26.7)
Lung	96	32.7 (26.0–39.4)	153	40.4 (33.8–47.0)	93	35.3 (28.1–42.6)	91	41.3 (32.6–49.9)	42	36.1 (24.8–47.3)
Stomach	56	17.4 (12.7–22.1)	87	21.8 (17.1–26.5)	72	27.8 (21.4–34.3)	72	32.2 (24.6–39.8)	49	39.7 (28.1–51.3)
Oral cavity	26	9.2 (5.6–12.8)	46	13.3 (9.4–17.2)	51	19.1 (13.8–24.4)	42	17.8 (12.3–23.3)	28	19.2 (11.7–26.8)

Primary tumor location	Social vulnerability strata

	SVS 1 (least vulnerable)	SVS 2	SVS 3	SVS 4	SVS 5 (most vulnerable)
All neoplasms^b	0.69	0.63	0.53	0.51	0.49
Prostate	0.89	0.89	0.89	0.85	0.83
Colorectal	0.73	0.64	0.57	0.53	0.50
Lung	0.31	0.23	0.13	0.07	0.08
Stomach	0.42	0.43	0.31	0.25	0.23
Oral cavity	0.73	0.61	0.57	0.60	0.56

Primary location	Incidence		Mortality		Difference in SVS1-SVS5 survival %

	RR SVS5/SVS1	RII	RR SVS5/SVS1	RII
All neoplasms^a	0.72 (0.71–0.74) ^b	0.66 (0.62–0.69) ^c	1.17 (1.02–1.34)	1.19 (1.05–1.34)	20
Prostate	0.99 (0.85–1.15)	0.96 (0.82–1.11)	1.33 (1.00–1.79)	1.73 (1.16–2.59)	6
Colorectal	0.37 (0.29–0.48)	0.32 (0.23–0.43)	0.72 (0.46–1.11)	0.64 (0.39–1.07)	23
Lung	0.83 (0.60–1.16)	0.78 (0.64–0.95)	1.10 (0.75–1.62)	1.12 (0.86–1.46)	23
Stomach	1.71 (1.18–2.49)	1.78 (1.54–2.06)	2.28 (1.44–3.63)	2.71 (2.52–2.91)	20
Oral cavity	1.27 (0.90–1.79)	1.44 (1.25–1.67)	2.08 (1.13–3.86)	2.22 (1.58–3.13)	17

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[1] Correspondence: Maria do Carmo Ferreira Rua da Lagoa, 152 13104-118 Campinas, SP, Brasil E-mail: mcarmoferreira12@gmail.com