| Author | Guimarães, Joanna M. N. | |
| Author | Pescarini, Julia M. | |
| Author | Sousa Filho, J. Firmino de | |
| Author | Ferreira, Andrea | |
| Author | Almeida, Maria da Conceição C. de | |
| Author | Gabrielli, Ligia | |
| Author | Silva, Isabel dos Santos | |
| Author | Santos, Gervasio | |
| Author | Barreto, Mauricio L. | |
| Author | Aquino, Estela M. L. | |
| Access date | 2024-05-03T17:31:50Z | |
| Available date | 2024-05-03T17:31:50Z | |
| Document date | 2024 | |
| Citation | GUIMARÃES, Joanna M. N. et al. Income Segregation, Conditional cash transfers, and breast cancer mortality among women in Brazil. JAMA Network Open, v. 7, n. 1, p. 1-12, Jan. 2024. | en_US |
| ISSN | 2574-3805 | en_US |
| URI | https://www.arca.fiocruz.br/handle/icict/63859 | |
| Sponsorship | Wellcome Trust.
NIHR, Instituto Nacional de Pesquisa em Saúde e Cuidados, Aviso Universal.
Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq). | en_US |
| Language | eng | en_US |
| Publisher | American Medical Association | en_US |
| Rights | open access | en_US |
| Subject in Portuguese | Segregação de renda | en_US |
| Subject in Portuguese | Transferências condicionais de dinheiro | en_US |
| Subject in Portuguese | Mortalidade por câncer de mama | en_US |
| Subject in Portuguese | Mulheres | en_US |
| Subject in Portuguese | Brasil | en_US |
| Title | Income segregation, conditional cash transfers, and breast cancer mortality among women in Brazil | en_US |
| Type | Article | en_US |
| DOI | 10.1001/jamanetworkopen.2023.53100 | |
| Abstract | Importance: Women living in income-segregated areas are less likely to receive adequate breast cancer care and access community resources, which may heighten breast cancer mortality risk. Objective: To investigate the association between income segregation and breast cancer mortality and whether this association is attenuated by receipt of the Bolsa Família program (BFP), the world's largest conditional cash-transfer program. Design, setting, and participants: This cohort study was conducted using data from the 100 Million Brazilian Cohort, which were linked with nationwide mortality registries (2004-2015). Data were analyzed from December 2021 to June 2023. Study participants were women aged 18 to 100 years. Exposure: Women's income segregation (high, medium, or low) at the municipality level was obtained using income data from the 2010 Brazilian census and assessed using dissimilarity index values in tertiles (low [0.01-0.25], medium [0.26-0.32], and high [0.33-0.73]). Main outcomes and measures: The main outcome was breast cancer mortality. Mortality rate ratios (MRRs) for the association of segregation with breast cancer deaths were estimated using Poisson regression adjusted for age, race, education, municipality area size, population density, area of residence (rural or urban), and year of enrollment. Multiplicative interactions of segregation and BFP receipt (yes or no) in the association with mortality (2004-2015) were assessed. Results: Data on 21 680 930 women (mean [SD] age, 36.1 [15.3] years) were analyzed. Breast cancer mortality was greater among women living in municipalities with high (adjusted MRR [aMRR], 1.18; 95% CI, 1.13-1.24) and medium (aMRR, 1.08; 95% CI, 1.03-1.12) compared with low segregation. Women who did not receive BFP had higher breast cancer mortality than BFP recipients (aMRR, 1.17; 95% CI, 1.12-1.22). By BFP strata, women who did not receive BFP and lived in municipalities with high income segregation had a 24% greater risk of death from breast cancer compared with those living in municipalities with low income segregation (aMRR, 1.24: 95% CI, 1.14-1.34); women who received BFP and were living in areas with high income segregation had a 13% higher risk of death from breast cancer compared with those living in municipalities with low income segregation (aMRR, 1.13; 95% CI, 1.07-1.19; P for interaction = .008). Stratified by the amount of time receiving the benefit, segregation (high vs low) was associated with an increase in mortality risk for women receiving BFP for less time but not for those receiving it for more time (<4 years: aMRR, 1.16; 95% CI, 1.07-1.27; 4-11 years: aMRR, 1.09; 95% CI, 1.00-1.17; P for interaction <.001). Conclusions and relevance: These findings suggest that place-based inequities in breast cancer mortality associated with income segregation may be mitigated with BFP receipt, possibly via improved income and access to preventive cancer care services among women, which may be associated with early detection and treatment and ultimately reduced mortality. | en_US |
| Affilliation | Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimento para Saúde. Salvador, BA, Brasil. | en_US |
| Affilliation | Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimento para Saúde. Salvador, BA, Brasil / Faculty of Epidemiology and Population Health. London School of Hygiene and Tropical Medicine. London, United Kingdom. | en_US |
| Affilliation | Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimento para Saúde. Salvador, BA, Brasil. | en_US |
| Affilliation | Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimento para Saúde. Salvador, BA, Brasil / Ubuntu Center on Racism. Global Movements and Population Health Equity. Drexel University Dornsife School of Public Health. Philadelphia, Pennsylvania. | en_US |
| Affilliation | Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil. | en_US |
| Affilliation | Secretaria de Saúde do Estado da Bahia. Centro de Diabetes e Endocrinologia da Bahia. Salvador, BA, Brasil. | en_US |
| Affilliation | Faculty of Epidemiology and Population Health. London School of Hygiene and Tropical Medicine. London, United Kingdom. | en_US |
| Affilliation | Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimento para Saúde. Salvador, BA, Brasil. | en_US |
| Affilliation | Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimento para Saúde. Salvador, BA, Brasil / Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil. | en_US |
| Affilliation | Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil. | en_US |
| Subject | Income segregation | en_US |
| Subject | Conditional cash transfers | en_US |
| Subject | Breast cancer mortality | en_US |
| Subject | Women | en_US |
| Subject | Brazil | en_US |
| DeCS | Fatores socioeconômicos | en_US |
| DeCS | Programas de transferências financeiras | en_US |
| DeCS | Mortalidade | en_US |
| DeCS | Neoplasias da mama | en_US |
| DeCS | Mulheres | en_US |
| DeCS | Brasil | en_US |
| xmlui.metadata.dc.subject.ods | 03 Saúde e Bem-Estar | |
| xmlui.metadata.dc.subject.ods | 05 Igualdade de gênero | |
| xmlui.metadata.dc.subject.ods | 10 Redução das desigualdades | |
