Geographical and temporal analysis of avoidable mortality from cervical cancer in Costa Rica
DOI:
https://doi.org/10.51481/amc.v49i3.321Keywords:
avoidable mortality, geographical analysis, cervicouterino CancerAbstract
Justification and objective: Uterine cervical cancer is one of the main causes of death in Costa Rican women, more than half of those deaths occur before 65 years of age. The main objective of this investigation was to identify patterns of avoidable high mortality in different health areas following a a temporo-spacial analysis in order to prioritize interventions right from the health services level.
Methods: To analyze the evolution we utilized the standardized annual mortality rate and the annual percentage of change estimated by a regression model according to Poisson.
For the geographical analysis we used the geographic representation of the standardized mortality ratio and the areas with a mortality rate significantly different from the national average.
Results: Between 1970 and 2005 avoidable mortality by uterine cervical cancer decreased approximately 2% and a mortality gradient was registered according to the age. With the geographical analysis we determined the existence of high variability between health areas (the mortality rate of the area located in percentile 95 is 18 times greater than the health area located in percentile 5) and a suggestion of a geographical pattern with rates of mortality superior to the national average both in the atlantic zone and the southern part of the country.
Conclusions: The annual occurrence of tens of avoidable deaths and the geographical variability in mortality rate between health areas, should constitute an alert sign of potential problems of attention regarding this entity. We recommended improving the detection process and the opportune approach to uterine cervical cancer, prioritizing interventions in the health areas with high mortality rates.
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References
Organización Mundial de la Salud. Datos sobre el cáncer. Nota descriptiva N°297, febrero 2006. Disponible en: http://www.who.int/ mediacentre/factsheets/fs297/es/print.html
Situación de salud en las Américas: Indicadores básicos 2005. OPS, 2006. Disponible en: http://www.paho.org/spanish/dd/ais/IB-folleto2005.pdf.
Rutstein D, Berenberg W, Chalmers T, Child C, Fishman A, Perrin E. Measuring the quality of medical care: a clinical method. N Engl J Med 1976; 294: 582-588.
Charlton J, Hartley RM, Silver R, Holland WW. Geographical variation in mortality from conditions amenable to medical intervention in England and Wales. Lancet 1983; I: 691-696.
Gispert R, Barés A, Freitas A, Torné M, Puigdefábregas A, Alberquilla A, et al. La mortalidad evitable: lista de consenso para la actualización del indicador en España. Gac. Sanit. 2006; 20: 184-193.
Holland W and the EC Working Group on Health Services and ""Avoidable Death"", eds. Eurpean Community Atlas of Avoidable Death 1985-1989. 3rd ed. Oxford: Oxford University Press; 1997.
Gispert R, Barés A, Freitas A, Torné M, Puigdefábregas A, Alberquilla A, et al. Medida del resultado de las intervenciones sanitarias en España: una aproximación mediante el análisis temporal y espacial de la mortalidad evitable entre 1986-2001. Rev Esp Salud Pública 2006, 80: 139-155.
Treurniet F, Boshuizen C, Harteloh M. Avoidable mortality in Europe (1980-1997): a comparison of trends. J Epidemiol Community Health 2004; 58: 290-295.
James P, Doug M, Yang M. Avoidable mortality across Canada from 1975 to 1999. BMC Public Health 2006, 6: 137.
Nolte E, McKee M (2003). Measuring the health of nations: analysis of mortality amenable to health care. BMJ 2003; 327: 389-494.
Dzul K, Puerto M, González M. Cáncer cervicouterino: métodos actuales para su detección. Rev Biomed 2004; 15: 233-241.
Martínez Piedra R., et al. SIGEpi: Sistema de Información Geográfica en Epidemiología y Salud Pública. Boletín Epidemiológico/OPS, 22:4-5, 2001.
Organización Panamericana de la Salud (OPS). Cooperación técnica de la OPS en sistemas de información geográfica aplicados en epidemiología (SIG-EPI) en las Américas. Boletín Epidemiológico/ OPS, 17: 8-10, 1996.
Organización Panamericana de la Salud. Clasificación Estadística Internacional de Enfermedades y Problemas Relacionados con la Salud. 10ª. revisión. OPS, Washington, D.C., 1995.
Puig X, Ginebra J y Gispert R. Análisis de la evolución temporal de la mortalidad mediante modelos lineales generalizados. Gac Sanit. 2005; 19: 481-5.
Pennello GA, Devesa SS, Gail MH. Using a mixed model to estimate geographic variation in cancer rates. Biometrics 1999; 55: 774-81.
López-Abente G, Escolar A, Errezola M, Abraira V. Atlas de mortalidad por cáncer y otras causas en España 1978-1992. Fundación Científica de la Asociación Española contra el Cáncer Madrid, 1996.
Sasiensi P, Adams J. Effect of screening on cervical cancer mortality in England and Wales. Analysis of trends with an age period cohort model. BMJ 1999; 318: 1244-5.
Parkin DM, Moss SM. An evaluation of screening policies for cervical cancer in England and Wales using a computer simulation model. J Epidemiol Community Healt 1986; 40: 143-153.
Herrero R, Brinton L, Reeves W, Brenes M, De Britton R, Gaitan E, Tinoco F. Screening for Cervical Cancer in Latin America: a casecontrol study. Int J Epidemiol 1992; 21: 1050-6.
Miller A. Report of a Worshop of the UICC project on evaluation of screening for cancer. International Journal of Cancer, 1990, 46: 76769.
Nazzal O, Reinero M, Abarzúa A, Liendo R y Palma C. Patología preinvasora del cerviz. Rev Chil Ginecol. 2003; 68: 189-196.
Novoa R. Análisis coste-efectividad del programa de detección sistemática del cáncer cervical en la región de Algarbe Portugal. Rev Esp Salud Pública 2004; 78: 341-353.
Organización Mundial de la Salud. Programas nacionales de control del cáncer: políticas y pautas para la gestión. OMS, Washington, D.C., 2004.
Besag J, York JC, Mollié A. Bayesian image restoration, with two applications in spatial statistics (with discussion). Annals of the Institute of Statistical Mathematics. 1991. 43: 1-59.
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