Impacts of Sociodemographic Factors, Screening, and Organization of Health Services on Breast Cancer Mortality in Brazil: An Ecological Study of 20 Years

Abstract

Background. Breast cancer mortality is increasing in Brazil. This study examines the impact of sociodemographic factors, screening procedures, and primary healthcare (PHC) on breast cancer mortality. Methods. An ecological study analyzed secondary data of women diagnosed with breast cancer who died between 2000 and 2019. Sociodemographic factors, screening procedures, and PHC were examined in relation to breast cancer mortality. Statistical analyses included normality tests, Kruskal-Wallis and one-way ANOVA tests with post hoc comparisons, Pearson and Spearman correlation tests, age-period-cohort analysis, Kaplan-Meier analysis, and Cox regression analysis. Significance was set at $p<0.05$ . Results. Mortality rates were higher in the southeast (15.77) and south (15.97) regions compared to the north (5.07) ( $p<0.0001$ ). Survival rates were longer in the southeast ( $70.3\pm 0.05$ ) and south ( $70.6\pm 0.09$ ) than in the north ( $63.98\pm 0.053$ ) ( $p\le 0.001$ ). Mortality increased with age after 32 years ( $p\le 0.001$ ). Brown and indigenous women had lower mortality and survival rates. Increased coverage of PHC, ultrasound, and biopsy did not reduce mortality. However, improved cytopathologic analysis led to a decrease in mortality. Conclusions. Sociodemographic factors, screening procedures, and PHC are specific predictors of breast cancer mortality in Brazil.