Banca de DEFESA: VANESSA MARINHO GONÇALVES DE SOUZA

EFFECT OF FAMILY HEALTH STRATEGY COVERAGE ON MORTALITY FROM CERVICAL CANCER IN BRAZILIAN MUNICIPALITIES

Cervical cancer; Mortality; Family Health Strategy; Effect evaluation.

Introduction: The mortality rate (MT) due to cervical cancer (CC) in Brazil shows a trend towards a significant reduction, but it is unequally distributed throughout the country, with higher rates in regions with lower socioeconomic development. Studies show that regions with effective screening programs have significantly reduced incidence and mortality rates, with the occurrence of this type of cancer being highly preventable in the population of people with a uterus. Primary Care, especially the Family Health Strategy (FHS), develops actions to control cervical cancer and plays a significant role in expanding the tracking and monitoring of the target population. Objective: The objective of the present study was to evaluate the effect of ESF coverage on reducing mortality from cervical cancer in Brazilian municipalities, between 2010 and 2019. Methodology: This is an ecological study, including 4548 Brazilian municipalities, in the period from 2010 to 2019. Crude mortality rates were calculated for the total population and for the age group of the target population for screening (25 to 64 years), the crude mortality rates for the total population and for the age group of the target population of screening (25 to 64 years old) according to FSH coverage levels and coverage of the screening indicator for each municipality per year. FSH coverage was categorized into three levels: without ESF and incipient (<30%), intermediate (>=30% and <70% or >= 70%, for less than the previous four years) and consolidated (>= 70%, for the minimum period of 4 previous years). Multivariate regression analyzes were performed using panel data, using negative binomial regression models with fixed effects, and adjusted for socioeconomic and demographic covariates considered relevant. Analyzes were also carried out stratified by population size, ratio indicator of cervical cytopathological examinations and HDI. Results: The average crude mortality rates for the total population and for the age group of the target population decreased by 7.92% and 16.53%, respectively, in the period studied. The increase in ESF coverage was associated with a reduction in the mortality rate for the total population and for the age group of the screening target population in some of the crude models, but the effect was not maintained after adjustment for confounding variables, further studies are needed to verify these associations. Conclusion: The findings of this study suggest that the expansion of municipal coverage of the ESF can influence reducing mortality from cervical cancer through control actions developed within the scope of Primary Care, such as adequate screening of the target population, education and awareness of the target audience about the importance of adhering to the exam at appropriate intervals, in addition to increasing vaccination coverage against the HPV virus.