Asociación del nivel socioeconómico y educacional en los egresos por cáncer de mama en Chile durante los años 2001 al 2016
Date
2021
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Revista ANACEM
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Abstract
Introducción El cáncer de mama constituye la primera causa de muerte en los cánceres
en Chile según Globocan 2018. Dentro de los factores que explican esta alta mortalidad
encontramos una baja tasa de detección y de realización de mamografías en los niveles
socioeconómicos altos. Es por esto que comprender las causas de defunción y los
factores que afectan en la mortalidad y letalidad por cáncer de mama en los últimos 17
años nos permitirá enfocar las políticas públicas de los próximos 50 años.
Los objetivos generales de este trabajo fueron caracterizar los egresos hospitalarios en
los pacientes por cáncer de mama según la edad, el sexo, la previsión, el nivel
socioeconómico y educacional en Chile durante los años 2001 al 2016 y calcular la
mortalidad y letalidad específica en estas mismas variables durante los años 2001 a
2016.
El objetivo específico es asociar las variables socioeconómicas y educacionales,
estimando los Odd’s ratios de las variables en los egresos hospitalarios por cáncer de
mama en Chile durante los años 2001 al 2016.
Palabras claves: cáncer de mama, nivel socioeconómico, nivel educacional, mortalidad
y letalidad.
Materiales y Métodos: Estudio de cohorte longitudinal retrospectivo en 81,072 egresos
hospitalarios y 20,220 defunciones obtenidas de la página DEIS MINSAL, años 2001 -
2016. Para el análisis univariado se efectuó una regresión de ajuste de tasas Praisweinstein según edad y sexo según modelo OMS de ajuste de tasas. Para las variables
de tipo discreta se describieron mediante porcentajes y tasas y para las variables de tipo
continua se utilizó mediana y desviación estándar. Se efectuó un test de smirnovkolmolgorov para determinar el tipo de distribución y de normalidad de las muestras.
Para las variables de tipo dicotómica se utilizó un modelo de regresión logística binaria
para describir estas variables y determinar la posible asociación entre el nivel
socioeconómico y educacional de las pacientes diagnosticadas por cáncer de mama.
Resultados
Murieron 1,88 veces más personas de nivel socioeconómico alto con un IC entre 1,83-
1,94 con respecto a la población de nivel socioeconómico bajo. En cambio, las personas
con un mayor nivel educacional murieron 0,5 veces menos según la regresión realizada
respecto al bajo nivel educacional con un IC entre 0,47- 0,52, pero a menor nivel
educacional aumentó 20 veces la mortalidad, constituyendo una causa inversa.
Respecto al sexo las mujeres murieron 2,08 veces más que los hombres.
Para el nivel socioeconómico alto en relación al bajo un OR [1.88 (1.83 a 1,94)],
p<0,0001], para el nivel educacional alto en relación al bajo fue a favor del mayor nivel
educacional con OR [0,5 (0,47 - 0,52)] y en cuanto a la comparación de sexos un OR
[1,04 (1,03-2,17), p=0,039]. Es decir, la diferencia entre mortalidad que hubo fue
significativa para todos los intervalos tanto para sexo, nivel educacional como para nivel
socioeconómico.
Se encontró una constante de 0,013 de mortalidad basal, es decir, todos tienen 1,3% de
riesgo de morir por cáncer de mama independiente del nivel socioeconómico,
educacional y del sexo.
Conclusión
Existen diferencias estadísticamente significativas respecto a la mortalidad entre los
niveles socioeconómicos altos y bajos y también en nivel educacional, sin embargo, al
realizar los métodos de regresión se obtuvo una mayor mortalidad y mayor riesgo de
morir por cáncer de mama en los niveles socioeconómicos más altos asociados a,
probablemente, la menor cantidad de tamizajes y realización de mamografías en este
estrato. A partir del año 2008 se observó un incremento a los niveles originales observados al inicio del segundo milenio incrementando las diferencias existentes en
los índices de desigualdad tanto por nivel educacional como por nivel socioeconómico
incrementando en 20 veces respecto al nivel educacional, y 1.88 respecto al nivel
socioeconómico.
Introduction: Breast cancer is the leading cause of death in cancers in Chile according to Globocan 2018. Among the factors that explain this high mortality, we find a low rate of detection and performance of mammograms in high socioeconomic levels. This is why understanding the causes of death and the factors that affect mortality and fatality from breast cancer in the last 17 years will allow us to focus on public policies for the next 50 years. Key words: breast cancer, socioeconomic levels, educational levels, mortality and fatality. Materials and Methods: Retrospective longitudinal cohort study in 79,996 hospital discharges and 20,220 deaths obtained from the DEIS MINSAL page, years 2001 -2016. For the univariate analysis, a Prais-Weinstein rate adjustment regression was performed according to age and sex according to the WHO rate adjustment model. For discrete type variables, they were described by percentages and rates, and median and standard deviation were used for continuous type variables. A smirnov-kolmolgorov test was performed to determine the type of distribution and normality of the samples. For dichotomous variables, a binary logistic regression model was used to describe these variables and determine the possible association between the socioeconomic and educational level of the patients diagnosed with breast cancer. Abstract: In this observational, longitudinal and retrospective study with 101.292 patients that includes men and women of all ages with diagnosis of breast cancer all along Chile, we´ll analyze the impact of socioeconomic level, evaluated through educational level and money income, into the prevalence, mortality and lethality of breast cancer in the years 2001 to 2016. Results: People with a high socioeconomic level died 1.88 times more, with a CI between 1.83 and 1.94, than those with a low socioeconomic level. On the other hand, people with a higher educational level died 0.5 times less according to the regression carried out with respect to the low educational level with a CI between 0.47 and 0.52, but the lower the educational level the mortality increased 20 times, constituting an inverse cause. Regarding sex, women died 2.08 times more than men. For the high socioeconomic level in relation to the low one an OR [1.88 (1.83 to 1.94)], p<0.0001], for the high educational level in relation to the low one it was in favor of the higher educational level with OR [0.5 (0.47 - 0.52)] and as for the comparison of sexes an OR [1.04 (1.03-2.17), p=0.039]. In other words, the difference between mortality was significant for all the intervals for sex, educational level and socioeconomic level. A constant baseline mortality of 0.013 was found, i.e., everyone has a 1.3% risk of dying from breast cancer regardless of socioeconomic level, educational level and sex. Conclusions: There are statistically significant differences in mortality between high and low socioeconomic levels and also in educational level; however, when regression methods were used, a higher mortality and higher risk of dying from breast cancer was obtained in the higher socioeconomic levels, probably associated with the lower number of screenings and mammograms performed in this stratum. As of 2008, an increase to the original levels observed at the beginning of the second millennium was observed, increasing the existing differences in the inequality indexes both by educational level and socioeconomic level, increasing by 20 times with respect to educational level, and 1.88 times with respect to socioeconomic level.
Introduction: Breast cancer is the leading cause of death in cancers in Chile according to Globocan 2018. Among the factors that explain this high mortality, we find a low rate of detection and performance of mammograms in high socioeconomic levels. This is why understanding the causes of death and the factors that affect mortality and fatality from breast cancer in the last 17 years will allow us to focus on public policies for the next 50 years. Key words: breast cancer, socioeconomic levels, educational levels, mortality and fatality. Materials and Methods: Retrospective longitudinal cohort study in 79,996 hospital discharges and 20,220 deaths obtained from the DEIS MINSAL page, years 2001 -2016. For the univariate analysis, a Prais-Weinstein rate adjustment regression was performed according to age and sex according to the WHO rate adjustment model. For discrete type variables, they were described by percentages and rates, and median and standard deviation were used for continuous type variables. A smirnov-kolmolgorov test was performed to determine the type of distribution and normality of the samples. For dichotomous variables, a binary logistic regression model was used to describe these variables and determine the possible association between the socioeconomic and educational level of the patients diagnosed with breast cancer. Abstract: In this observational, longitudinal and retrospective study with 101.292 patients that includes men and women of all ages with diagnosis of breast cancer all along Chile, we´ll analyze the impact of socioeconomic level, evaluated through educational level and money income, into the prevalence, mortality and lethality of breast cancer in the years 2001 to 2016. Results: People with a high socioeconomic level died 1.88 times more, with a CI between 1.83 and 1.94, than those with a low socioeconomic level. On the other hand, people with a higher educational level died 0.5 times less according to the regression carried out with respect to the low educational level with a CI between 0.47 and 0.52, but the lower the educational level the mortality increased 20 times, constituting an inverse cause. Regarding sex, women died 2.08 times more than men. For the high socioeconomic level in relation to the low one an OR [1.88 (1.83 to 1.94)], p<0.0001], for the high educational level in relation to the low one it was in favor of the higher educational level with OR [0.5 (0.47 - 0.52)] and as for the comparison of sexes an OR [1.04 (1.03-2.17), p=0.039]. In other words, the difference between mortality was significant for all the intervals for sex, educational level and socioeconomic level. A constant baseline mortality of 0.013 was found, i.e., everyone has a 1.3% risk of dying from breast cancer regardless of socioeconomic level, educational level and sex. Conclusions: There are statistically significant differences in mortality between high and low socioeconomic levels and also in educational level; however, when regression methods were used, a higher mortality and higher risk of dying from breast cancer was obtained in the higher socioeconomic levels, probably associated with the lower number of screenings and mammograms performed in this stratum. As of 2008, an increase to the original levels observed at the beginning of the second millennium was observed, increasing the existing differences in the inequality indexes both by educational level and socioeconomic level, increasing by 20 times with respect to educational level, and 1.88 times with respect to socioeconomic level.
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Los autores declaran no tener conflictos de intereses en relacióna este artículo. Sin fuentes de financiamiento.
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