Key Words: breast neoplasms, breast cancer, mortality statistics, spatial analysis
Abstract
Introduction
Breast cancer is the most common malignancy in women worldwide and Chile, being the leading cause of female cancer death. A wide variation in mortality has been reported, with geographic clusters of higher risk.
Objective
To spatially analyze mortality from breast cancer in women in the Metropolitan Region in 2015.
Methods
Ecological study of location. We used death records in 2015 (C50 according to ICD10) and population projections of the Statistics Institute to estimate mortality rates. We calculated crude breast cancer mortality rates and standardized mortality ratios and performed a spatial epidemiological analysis of breast cancer mortality in women, estimating the global and local Moran I index to assess spatial autocorrelation. We present the results in maps according to the 2016 pre-census cartography.
Results
There were 622 deaths from breast cancer in the Metropolitan Region in 2015. The mean age was 66 years (SD: 15.5). 92.4% of deaths were registered in urban or central areas. However, the highest mortality rates were observed in peripherical districts. No global spatial autocorrelation was observed in the region (Moran’s I 0.007 p = 0.134). However, at the local level, four districts differ significantly from their neighbors.
Conclusions
The risk of dying from breast cancer in the Metropolitan Region of Chile is concentrated in women from peripherical communes. Four districts in the region present different risks from their neighboring districts. It is necessary to investigate local realities to prevent deaths from this pathology.
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Introducción
El cáncer de mama es la neoplasia maligna más común en las mujeres en todo el mundo y en Chile, siendo la primera causa de muerte oncológica femenina. Se ha reportado amplia variación en la mortalidad, con focos geográficos de mayor riesgo.
Objetivo
Analizar espacialmente la mortalidad por cáncer de mama en mujeres de la Región Metropolitana en 2015.
Métodos
Estudio ecológico. Se utilizaron los datos de los registros de defunciones del año 2015 (C50 según CIE10), y las proyecciones poblacionales del Instituto Nacional de Estadísticas. Se calcularon tasas de mortalidad por cáncer de mama brutas y razones de mortalidad estandarizadas. Se realizó un análisis epidemiológico espacial estimando el índice I de Moran Global y Local para evaluar autocorrelación espacial. Los resultados se presentan en mapas (cartografía precenso 2016).
Resultados
Se registraron 622 defunciones por cáncer de mama en la Región Metropolitana en 2015. La edad promedio de las mujeres fallecidas fue de 66 años (desviación estándar: 15,5). El 92,4% de las muertes se registró en zonas centrales o urbanas. Sin embargo, las mayores tasas de mortalidad se observaron en comunas periféricas. No se observó autocorrelación espacial global en la región (I de Moran de 0,007; p = 0,134). A nivel local, cuatro comunas se diferencian de forma significativa de sus vecinas.
Conclusiones
El riesgo de morir por cáncer de mama en la Región Metropolitana de Chile se concentra en comunas periféricas. Cuatro comunas de la región presentan riesgos diferentes de sus comunas vecinas, por lo que es necesario explorar factores que explican la desigual distribución de las muertes.
Authors:
Doris Durán[1,2], María José Monsalves[2]
Affiliation:
[1] Programa de Doctorado en Salud Pública, Escuela de Salud Pública, Facultad de Medicina, Universidad de Chile, Santiago, Chile
[2] Facultad de Medicina y Ciencia, Universidad San Sebastián, Santiago, Chile
E-mail: doris.duran@uss.cl
Author address:
[1] Facultad de Medicina y Ciencia Universidad San Sebastián Lota 2465 Santiago 7510157 Chile
Citation: Durán D, Monsalves M. Spatial autocorrelation of breast cancer mortality in the Metropolitan Region, Chile: an ecological study. Medwave 2020;20(1):e7766 doi: 10.5867/medwave.2020.01.7766
Submission date: 28/8/2019
Acceptance date: 26/12/2019
Publication date: 27/1/2020
Origin: No solicitado
Type of review: Con revisión por pares externa, por dos árbitros, a doble ciego
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