The mortality data were available from 1996 to 2019 at the time of the analysis. In addition to the national trends in mortality rates, the authors evaluated this information for the five geographic regions in Brazil. Historically, the North and the Northeast are regions with the highest poverty indexes in the country. On the other hand, the South and Southeast are the most populous and industrialized regions.
Nowadays, different world “standard” populations can be chosen for these epidemiological studies. For example, the World Health Organization (WHO) provides a “standard” population with fewer children and more elderly aged 70 and above than the world standard. However, the Segi World standard is still widely used. It was our foundation to calculate the age-standardized mortality rates (ASMRs), expressed as per 100,000 persons per year. Finally, the changes in the trends were identified by the Joinpoint Regression Program provided by the National Cancer Institute (NCI, Bethesda, MD).
Regarding the national data, all the urological malignancies presented significant upward trends, with the exception of prostate cancer which revealed a downward trend since 2006. Nonetheless, if each one of the regions is analyzed, the Northeast and the North presented a sharp increase in the mortality trends for prostate cancer. Similar concerns can be found for the other urological cancers, particularly in these two northern Brazilian regions.
Notably, a limitation of the conclusions depends on the accuracy of the raw data. This is a weak point in this type of study. Variables as the correct completion of death certificates are not manageable.
Ultimately, the authors intend with these results to support the expansion of health policies for developing oncological care, particularly in regions with more difficult access to the health system.
Written by: Thiago C. Mourão, MD, Department of Uro-Oncology, BP-A Beneficência Portuguesa de São Paulo, São Paulo, Brazil
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