Mortalidade por câncer do ovário nos estados da região Nordeste e Sul: análise do efeito de idade, período e coorte

Abstract

Ovarian cancer is highly associated with changes in women's reproductive behavior, becoming the seventh most incident cancer and the eighth cause of cancer death in women. At the population level, the differentials in incidence and mortality from this neoplasm are correlated with the population's age structure, especially with population aging and the reduction in the fertility rate. Notably, reproductive factors (nulliparity, not using oral contraceptives, never having breastfed) are responsible for more than 80% of the population's attributable risk of ovarian cancer. The temporal evolution of disease incidence and mortality is influenced by three temporal factors: age, period, and cohort. Thus, the present dissertation aims to evaluate the effect of age, period, and cohort (APC) on ovarian cancer mortality, in the period from 1980 to 2019, in the age groups from 30 to 80 years and over, in Brazilian states that present differences significant in the reproductive behavior of women, Federation Units of the Northeast and South of the country. Death records were extracted from the Mortality Information System (SIM/DATASUS), and population data were obtained from the Brazilian Institute of Statistics and Geography (IBGE). In order to obtain more reliable mortality rates, the quality and coverage of deaths were corrected. After correcting the deaths, crude mortality rates were calculated, specific by age group, and standardized by the direct method, using the world population proposed by Segi as the standard population. The APC effects were calculated for mortality rates in the five years from 1980-1984 to 2010-2019, using Poisson regression using estimable functions proposed by Holford and implemented by Carstensen. During the study period, the standardized mortality rate for 100,000 women in the South region was 3.75, and in the Northeast, 2.59. The highest standardized rates were observed in the states of the South region - Rio Grande do Sul (3.98/100,000 women) and Santa Catarina (3.70/100,000 women), and the lowest, in the states of the Northeast region - Paraíba (1.97 /100,000 women) and Alagoas (2.04/100,000 women). There were differences in the risk of death in the 2000s between the states of the South and Northeast regions, with an increase in the last five years in states of the Northeast region and a reduction in the states of the South region. of death from ovarian cancer in women of generations born from the 1950s onwards, and in Rio Grande do Sul reduction in younger cohorts. The differences in the period effect observed between the states of these two regions may be correlated with inequalities in access to health services from Primary Care to highly complex treatment in oncology. Moreover, the cohort effect (increased risk of ovarian cancer mortality in younger generations) is correlated with changes in reproductive behavior and the westernization of lifestyle habits.