RESUMO
BACKGROUND: Cervical cancer patients in Colombia have a lower likelihood of survival compared to breast cancer patients. In 1993, Colombia enrolled citizens in one of two health insurance regimes (contributory-private insurance and subsidized- public insurance) with fewer benefits in the subsidized regime. In 2008, the Constitutional Court required the Colombian government to unify services of both regimes by 2012. This study evaluated the impact of this insurance change on cervical cancer mortality before and after 2012. METHODS: We accessed 24,491 cervical cancer mortality records for 2006-2020 from the vital statistics of Colombia's National Administrative Department of Statistics (DANE). We calculated crude mortality rates by health insurance type and departments (geopolitical division). Changes by department were analyzed by rate differences between 2006 and 2012 and 2013-2020, for each health insurance type. We analyzed trends using join-point regressions by health insurance and the two time-periods. RESULTS: The contributory regime (private insurance) exhibited a significant decline in cervical cancer mortality from 2006 to 2012, characterized by a noteworthy average annual percentage change (AAPC) of -3.27% (P = 0.02; 95% CI [-5.81, -0.65]), followed by a marginal non-significant increase from 2013 to 2020 (AAPC 0.08%; P = 0.92; 95% CI [-1.63, 1.82]). In the subsidized regime (public insurance), there is a non-significant decrease in mortality between 2006 and 2012 (AAPC - 0.29%; P = 0.76; 95% CI [-2.17, 1.62]), followed by a significant increase from 2013 to 2020 (AAPC of 2.28%; P < 0.001; 95% CI [1.21, 3.36]). Examining departments from 2013 to 2020 versus 2006 to 2012, the subsidized regime showed fewer cervical cancer-related deaths in 5 out of 32 departments, while 6 departments had higher mortality. In 21 departments, mortality rates remained similar between both regimes. CONCLUSION: Improvement of health benefits of the subsidized regime did not show a positive impact on cervical cancer mortality in women enrolled in this health insurance scheme, possibly due to unresolved administrative and socioeconomic barriers that hinder access to quality cancer screening and treatment.
Assuntos
Cobertura Universal do Seguro de Saúde , Neoplasias do Colo do Útero , Humanos , Colômbia/epidemiologia , Neoplasias do Colo do Útero/mortalidade , Feminino , Pessoa de Meia-Idade , Adulto , Seguro Saúde/estatística & dados numéricosRESUMO
Objetivo: Descrever a taxa bruta de mortalidade por câncer do colo do útero em Santa Catarina no período de 2000 2010. Método: Pesquisa descritiva de base populacional e dados obtidos junto ao SIM/DATASUS. Resultados: O número total de óbitos por câncer do colo do útero em Santa Catarina, no período estudado, foi de 1382, correspondendo a uma taxa de mortalidade que variou entre 3,6 (ano de 2006) e 4,9 (ano de 2000) por 100.000 mulheres. Verificou-se que a menor taxa de mortalidade referiu-se à faixa etária de 20-29 anos e as mais altas a partir dos 40 anos. Conclusões: Os dados apontaram para uma diminuição dos casos de óbitos em mulheres por câncer de colo de útero no decorrer do período estudado e apresentam ainda, que quanto maior a faixa etária maior a taxa bruta de mortalidade.
Objective: To describe the death rate from cervical cancer in Santa Catarina State in the 2000-2010 period. Method: Descriptive population-based and data obtained from the SIM / DATASUS. Results: The total number of deaths from cervical cancer in Santa Catarina, in the period studied, was 1382, corresponding to a mortality rate ranging from 3.6 (2006) and 4.9 (year 2000) per 100,000 women. It was found that the lowest mortality rate referred to the age group of 20-29 years old and the highest after 40 years. Conclusions: The data pointed to a decrease of deaths in women from cervical cancer, during the study period, and showed that higher the age the higher the death rate.
Objetivo: Describir la tasa de la mortalidad por cáncer de cuello uterino en Santa Catarina, en el período de 2000 a 2010. Método: Descriptivos de datos basados en la población y obtenida de la tarjeta SIM / DATASUS. Resultados: El número total de muertes por cáncer de cuello uterino en Santa Catarina, en el período estudiado fue de 1382, que corresponde a una tasa de mortalidad entre 3,6 (2006) y 4,9 (año 2000) por cada 100.000 mujeres. Fue posible verificar que la tasa de mortalidad más baja se refirió al grupo de edad entre 20-29 años y las más altas después de los 40 años. Conclusiones: Los datos apuntaron a una disminución de las muertes en mujeres por cáncer de cuello uterino durante el período de estudio y apuntaron también, que cuanto mayor la edad, más grande es la tasa bruta de mortalidad.