Disparities in the spatio-temporal patterns of mortality from breast and cervical cancer in Argentina, 1996-2015

Abstract

While breast cancer (BC) is the main cause by cancer in women among countries with several development levels, there is a noticeable gap of mortality due to cervix cancer (CC) between high- and low-income countries. In Argentina, BC and CC are the first and fifth cause of death by cancer among women, respectively.

The objectives were to describe mortality trends by BC and CC in Argentina during 1996-2015 and characterize the pattern of spatial distribution related to these mortality causes (2013-2015).

Mixed ecological study. A temporal trend and multigroup study (1996-2015; n=24 provinces) and a transversal multigroup design (2013-2015; n=511 counties) were carried out in Argentina. Mortality rates of BC and CC (1996 to 2015), age-standardized (SMR) by the direct method (world population as reference), were estimated using data from the Department of Health Information and Statistics of Argentina and census population estimates (INDEC). For each province, the average annual percentage change (AAPC) of the SMR (1996-2015) was estimated by using Joinpoint regression analysis. Using the 2013-2015 average rates by cancer type, a spatial analysis of hot spots (by Getis-Ord) was conducted, mapping geographic clusters at the county level.

Significant decreases (p<0.05) in SMR for BC were observed between 1996-2015 in Buenos Aires, Córdoba, Santa Fe, San Juan and CABA (AAPC: 0.9 to 1.6%), and for CC in Entre Ríos, Formosa, Jujuy, Santa Cruz and Santiago del Estero (AAPC: 2.0 to 4.5%). The trend was increasing for CC in CABA (AAPC= 1.3%) and Tucumán (AAPC= 1.4%). For BC (2013-2015), the largest hot spots (high SMR) were located in Buenos Aires, while low SMR (cold spots) were concentrated in the northwest region. Conversely, the northern region of the country was identified as a hot spot for CC, with cold spots located in CABA and surroundings, and the border region between Córdoba and La Rioja.

Although the 1996-2015 mortality trend for both cancers was generally favorable (decreasing), there are provincial disparities in Argentina. In recent years, mortality spatial patterns were opposite between CC and BC.