INEQUALITY AND CANCER IN BRAZIL-INVESTMENT, INSTALLED HEALTH SERVICES CAPACITY AND SOCIAL DEVELOPMENT: A COMPARATIVE ANALYSIS OF THE FACTORS RELATED TO DIFFERENT CANCER OUTCOMES IN THE 26 STATES AND THE FEDERAL DISTRICT OF BRAZIL

Introduction: The incidence and mortality of cancer has been increasing all over the world, this phenomenon has multifactorial causes. Cancer incidence and mortality is influenced by factors as population ageing, life habits, access and quality of health services. This study evaluated the impact of discrepancies of socioeconomic and health assistance variables in the incidence, mortality and lethality by cancer in the 26 states and the Federal District of Brazil. Methods: The data were extracted from the Brazilian Institute of Geography and Statistics – IBGE, National Cancer Institute – INCA and the Brazilian Health Ministry database. The variables selected were human development index (HDI) Gini index, ageing rate, % poor population, number of hospital beds per 100 thousand habitants and % of population that owns health insurance plan. All these variables were correlated tothe incidence and mortality rates and to the mortality/incidence coefficient (lethality) by all neoplasms, prostate, breast and lung cancer and non- Hodgkin lymphoma. We performed normality tests and Pearsons correlation tests for normal variables and Spearmans correlation test for non- normal variables. Results: In relation to variables of social development and inequality, it is observed a positive correlation with incidence, mortality and lethality of all neoplasms analyzed. The greater the HDI, the older population and the lower the social inequality, the greater is the incidence (ρ = 0,749, p < 0,001) and mortality (ρ = 0.602, p < 0.001) by cancer. However, in this cases, there is a lower cancer lethality (ρ = -0.783, p < 0.001), indicating a better treatment outcome after a cancer diagnosis. The same correlation is observed in relation to the number of hospital beds per 100 thousand habitants (ρ = -0.499, p < 0.01) and the % of population that owns health insurance plan (ρ = -0.736, p < 0.001). Inverse correlation is observed for % poor population, the greater the proportion of poor people, the lower is the incidence (ρ = -0.824, p < 0.001) and the mortality (ρ = -0.686, p < 0.001), but the greater is lethality by cancer (ρ = 0.825, p < 0.001). Conclusion: The incidence, mortality and lethality of cancer is extremely variable among the Brazilian states. There is strong association between worse treatment outcomes in states with lower social development, greater social inequality and lower installed health services capacity.