Souza, Dyego Leandro Bezerra deLima, Kálya Yasmine Nunes de2022-05-202021-01-28LIMA, Kálya Yasmine Nunes de. Desigualdades na mortalidade e no estádio ao diagnóstico do câncer de pulmão no Brasil. 2021. 145f. Tese (Doutorado em Saúde Coletiva) - Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Natal, 2021.https://repositorio.ufrn.br/handle/123456789/47240The objective was to analyze the spatial distribution, occurrence of mortality and clinical tumor stage at the diagnosis of lung cancer and its relationship with socioeconomic factors and the provision of health services in Brazil. This is an ecological and cross-sectional study. Deaths (ICD-10: C33-34) were collected from the Mortality Information System for the period 2011- 2015. Individual data were extracted from the Hospital Cancer Records Integrator for the period 2006 to 2015 and contextual variables were collected from the Atlas of Human Development in Brazil, the National Register of Health Establishments and the National Supplementary Health Agency. To analyze mortality and advanced diagnosis of lung cancer, we applied the chi-square test and poisson regression with robust variance for a 95% confidence level. The spatial dependence of mortality rates and the Proportion of Advanced Stage Diagnosis (PASD) was verified by the global Moran index and the local indicator of spatial association. Early diagnosis was analyzed by Pearson's chi-square test and multilevel Poisson regression. The average age-adjusted mortality rate between 2011 and 2015 was 12.8 (SD 5.12) deaths per 100,000 inhabitants. High mortality rates from lung cancer were significantly associated with the density of general practitioners (PR 1.68; 95% CI 1.04-2.72), establishments qualified in oncology (PR 1.49; 95% CI 1.01- 2.20) and inversely associated with the proportion of people with low income (PR 1.73; 95% CI 1.11-2.68) and presented spatial autocorrelation (Moran's I 0.50). The multivariate spatial model consisted of the variables Density of licensed oncology health facilities, income and coverage of health plans. PASD was 85.28% (95% CI 83.31-87.10), with low spatial autocorrelation (Moran's I 0.37), and positive correlation with aging rate (Moran's I 0,10; p = 0.02), income (Moran's I 0.05) and negative with Gini (Moran's I -0.15). From 2006 to 2015, 87.71% of lung cancer cases were diagnosed at an advanced stage. The age group from 50 to 59 years (PR 1.04; 95% CI 1.03-1.05), male sex (PR 1.02; 95% CI 1.01-1.03), race/color not white (PR 1.02; 95% CI 1.01-1.03), incomplete primary education (PR 1.05; 95% CI 1.03-1.08) and small cell tumors (PR 1.08 ; 95% CI 1.06-1.09) are associated with diagnosis at an advanced stage. In the multilevel analysis, early staging was associated with individual factors and a lower density of family health strategy. There was no association with socioeconomic contextual variables. It is concluded that socioeconomic contexts and the provision of health services are determinants of inequalities in the distribution of lung cancer mortality rates. On the other hand, the stage of cancer at diagnosis is more associated with individual socioeconomic and tumor factors. The results indicate the importance of primary prevention measures, especially tobacco control. Strategies that reduce social inequalities must also be reinforced so that socioeconomic conditions do not increase the difficulties related to diagnosis.Acesso AbertoEpidemiologiaCâncer de pulmãoDesigualdades em saúdeDeterminantes sociais da saúdeEstadiamento de neoplasiasdoctoralThesis