Disparities in lung cancer case registration, treatment, and mortality: descriptive study, Brazil, 2013-2019

To analyze factors associated with lung cancer case registration, treatment and mortality in Brazil, 2013-2019.

This was a retrospective study using the Brazilian Mortality Information System (Sistema de Informação de Mortalidade - SIM) and the Hospital Cancer Registries (Registros Hospitalares de Câncer - RHC). Outcomes analyzed were: (Model 1) "absence of lung cancer case registration" in the RHC, and (Model 2) "rate of registered cases above the 3rd quartile." Descriptive and bivariate analyses were performed to compare groups, as well as multivariate logistic regression, identifying, at the municipal level, factors associated with the outcomes. Adjusted odds ratios (OR) and 95% confidence intervals (95%CI) were obtained.

A total of 206,703 deaths and 89,265 cases (43% coverage) were analyzed. Approximately 85.7% of patients were diagnosed at a late stage, and half of the cases with initial staging did not receive adequate treatment. In Model 1, a lack of RHC coverage was associated with municipalities in the Central-West region compared to those in the North [OR 3.9; 95%CI 2.7; 5.7] and with those having a Gross Domestic Product below the national average [OR 1.3; 95%CI 1.1; 1.7]. In Model 2, municipalities in the South [OR 9.1; 95% CI 6.8; 12.2], small-sized municipalities [OR 7.1; 95%CI 4.0; 12.3], and those with below-average travel distances for treatment [OR 4.2; 95%CI 2.3; 7.7] had increased odds of a high registration rate.

Localities with better infrastructure were more likely to register cases and have greater coverage of registries, while areas with poorer infrastructure were more likely not to register cases, despite presenting deaths due to lung cancer.