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https://www.arca.fiocruz.br/handle/icict/60666
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ArtigoDireito Autoral
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3100-12-31
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THE INTERSECTION OF RACE/ETHNICITY AND SOCIOECONOMIC STATUS: INEQUALITIES IN BREAST AND CERVICAL CANCER MORTALITY IN 20,665,005 ADULT WOMEN FROM THE 100 MILLION BRAZILIAN COHORT
racial inequalities
socioeconomic status
cancer
mortality
intersectionality
Autor(es)
Góes, Emanuelle Freitas
Guimarães, Joanna Miguez Nery
Almeida, Maria da Conceição C.
Gabrielli, Ligia
Katikireddi, Srinivasa Vittal
Campos, Ana Clara
Matos, Sheila M. Alvim
Patrão, Ana Luísa
Costa, Ana Cristina de Oliveira
Quaresma, Manuela
Leyland, Alastair H.
Barreto, Mauricio L.
dos-Santos-Silva, Isabel
Aquino, Estela M. L.
Guimarães, Joanna Miguez Nery
Almeida, Maria da Conceição C.
Gabrielli, Ligia
Katikireddi, Srinivasa Vittal
Campos, Ana Clara
Matos, Sheila M. Alvim
Patrão, Ana Luísa
Costa, Ana Cristina de Oliveira
Quaresma, Manuela
Leyland, Alastair H.
Barreto, Mauricio L.
dos-Santos-Silva, Isabel
Aquino, Estela M. L.
Afiliação
Centre for Data and Knowledge Integration for Health. Gonçalo Moniz Institute. Oswaldo Cruz Foundation. Salvador, BA, Brazil
Centre for Data and Knowledge Integration for Health. Gonçalo Moniz Institute. Oswaldo Cruz Foundation. Salvador, BA, Brazil
Gonçalo Moniz Institute. Oswaldo Cruz Foundation. Salvador, BA, Brazil
Centro de Diabetes e Endocrinologia da Bahia. Secretaria de Saúde do Estado da Bahia. Salvador, BA, Brazil/Instituto de Saúde Coletiva. Universidade Federal da Bahia. Salvador, BA, Brazil
MRC/CSO Social & Public Health SciencesUnit. University of Glasgow. Glasgow, UK
Centre for Data and Knowledge Integration for Health. Gonçalo Moniz Institute. Oswaldo Cruz Foundation. Salvador, BA, Brazil
Instituto de Saúde Coletiva. Universidade Federal da Bahia. Salvador, BA, Brazil
Center for Psychology. Faculty of Psychology and EducationScience. University of Porto. Porto, Portugal
Fundação Oswaldo Cruz. Programa de Pós-graduação em Saúde Coletiva do Instituto René Rachou. Belo Horizonte, MG, Brasil
Faculty of Epidemiology and Population Health. London School of Hygiene &Tropical Medicine. London, UK
MRC/CSO Social & Public Health SciencesUnit. University of Glasgow. Glasgow, UK
Centre for Data and Knowledge Integration for Health. Gonçalo Moniz Institute. Oswaldo Cruz Foundation. Salvador, BA, Brazil/Instituto de Saúde Coletiva. Universidade Federal da Bahia. Salvador, BA, Brazil
Faculty of Epidemiology and Population Health. London School of Hygiene &Tropical Medicine. London, UK
Instituto de Saúde Coletiva. Universidade Federal da Bahia. Salvador, BA, Brazil
Centre for Data and Knowledge Integration for Health. Gonçalo Moniz Institute. Oswaldo Cruz Foundation. Salvador, BA, Brazil
Gonçalo Moniz Institute. Oswaldo Cruz Foundation. Salvador, BA, Brazil
Centro de Diabetes e Endocrinologia da Bahia. Secretaria de Saúde do Estado da Bahia. Salvador, BA, Brazil/Instituto de Saúde Coletiva. Universidade Federal da Bahia. Salvador, BA, Brazil
MRC/CSO Social & Public Health SciencesUnit. University of Glasgow. Glasgow, UK
Centre for Data and Knowledge Integration for Health. Gonçalo Moniz Institute. Oswaldo Cruz Foundation. Salvador, BA, Brazil
Instituto de Saúde Coletiva. Universidade Federal da Bahia. Salvador, BA, Brazil
Center for Psychology. Faculty of Psychology and EducationScience. University of Porto. Porto, Portugal
Fundação Oswaldo Cruz. Programa de Pós-graduação em Saúde Coletiva do Instituto René Rachou. Belo Horizonte, MG, Brasil
Faculty of Epidemiology and Population Health. London School of Hygiene &Tropical Medicine. London, UK
MRC/CSO Social & Public Health SciencesUnit. University of Glasgow. Glasgow, UK
Centre for Data and Knowledge Integration for Health. Gonçalo Moniz Institute. Oswaldo Cruz Foundation. Salvador, BA, Brazil/Instituto de Saúde Coletiva. Universidade Federal da Bahia. Salvador, BA, Brazil
Faculty of Epidemiology and Population Health. London School of Hygiene &Tropical Medicine. London, UK
Instituto de Saúde Coletiva. Universidade Federal da Bahia. Salvador, BA, Brazil
Resumo em Inglês
Objectives:There is limited evidence regarding the impact of race/racism and its intersection with socioeconomic status (SES) onbreast and cervical cancer, the two most common female cancersglobally. We investigated racial inequalities in breast and cervicalcancer mortality and whether SES (education and householdconditions) interacted with race/ethnicity.Design:The 100 Million Brazilian Cohort data were linked to theBrazilian Mortality Database, 2004–2015 (n = 20,665,005 adultwomen). We analysed the association between self-reported race/ethnicity (White/‘Parda’(Brown)/Black/Asian/Indigenous) andcancer mortality using Poisson regression, adjusting for age,calendar year, education, household conditions and area ofresidence. Additive and multiplicative interactions were assessed.Results:Cervicalcancermortalityrateswerehigher amongIndigenous(adjusted Mortality rate ratio = 1.80, 95%CI 1.39–2.33), Asian (1.63, 1.20–2.22),‘Parda’(Brown) (1.27, 1.21–1.33) and Black (1.18, 1.09–1.28)women vs White women. Breast cancer mortality rates were higheramong Black (1.10, 1.04–1.17) vs White women. Racial inequalities incervical cancer mortality were larger among women of poor household conditions, and low education (P for multiplicativeinteraction <0.001, and 0.02, respectively). Compared to Whitewomen living in completely adequate (3–4) household conditions,the risk of cervical cancer mortality in Black women with 3–4, 1–2,and none adequate conditions was 1.10 (1.01–1.21), 1.48 (1.28–1.71),and 2.03 (1.56–2.63), respectively (Relative excess risk due tointeraction-RERI = 0.78, 0.18–1.38). Among‘Parda’(Brown) women therisk was 1.18 (1.11–1.25), 1.68 (1.56–1.81), and 1.84 (1.63–2.08),respectively (RERI = 0.52, 0.16–0.87). Compared to high-educatedWhite women, the risk in high-, middle- and low-educated Blackwomen was 1.14 (0.83–1.55), 1.93 (1.57–2.38) and 2.75 (2.33–3.25),respectively (RERI = 0.36,−0.05–0.77). Among‘Parda’(Brown) womenthe risk was 1.09 (0.91–1.31), 1.99 (1.70–2.33) and 3.03 (2.61–3.52),respectively (RERI = 0.68, 0.48–0.88). No interactions were found forbreast cancer.Conclusion:Low SES magnified racial inequalities in cervical cancermortality. The intersection between race/ethnicity, SES and genderneeds to be addressed to reduce racial health inequalities.
Palavras-chave em inglês
Racismracial inequalities
socioeconomic status
cancer
mortality
intersectionality
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