Newton001-Developing tools to study inequalities in women's access to breast and cervical cancer control activities in Brazil using health-related DB

巴西与许多其他低收入和中等收入国家一样，正在经历癌症转型，感染相关病因的癌症正在被非传染性起源的癌症所超越。这一转变在妇女中尤为明显，乳腺癌现已超过宫颈癌，成为巴西最常见的女性癌症（2012年发病病例估计数：乳腺癌约67 000例，宫颈癌约18 000例）。巴西政府于1988年建立了Sistema Musnico de Saude（SUS），以提供全民免费医疗服务。1999-2002年，颁布了25-59岁妇女每三年进行一次妇科检查的指导方针，2004年，颁布了50-64岁妇女每两年进行一次乳房X光检查的指导方针，并建立了管理这些检查活动的信息系统。1999年实施的SISCOLO记录了所有巴氏涂片检查申请的信息，而2009年建立的SISMAMA记录了所有乳房X线照片的数据。尽管这些项目取得了成功，而且巴西的BC发病率低于英国，（2012年为59.5/100，000与95/100，000），BC死亡率相似（分别为14.3/100，000和17.1/100，000），巴西的CC发病率和死亡率仍然高得多（分别为16.3/100，000和7.3/100，000）比英国（分别为7.1/100，000和1.8/100，000）。这种不成比例的高死亡率很可能与筛查的目标人群覆盖率低和就诊晚有关。这一研究伙伴关系的目的是调查情况是否如此，首先，通过创建必要的工具来研究两种最常见的女性癌症-乳腺癌和乳腺癌-获得早期诊断和治疗的情况。具体而言，我们将：1.在国家一级获得SISMAMA和SISCOLO国家数据，并将其与人口普查、医院和死亡率记录、社会经济调查和Bolsa Familia联系起来。制定一个多学科概念框架，利用这种全面的数据联系，确定医疗保健不平等的需求（如社会经济地位、信仰体系）和供应决定因素（如服务提供情况）。加强分析能力，以应对通过询问大量非正式收集的数据集而提出的方法挑战。这些措施包括解决影响关联数据的潜在偏见来源，以及采用适当的统计方法来审查导致保健不平等的途径。

Brazil, like many other low and middle-income countries (LMICs), is undergoing a cancer transition whereby cancers with an infection-related aetiology are being surpassed by those with a non-communicable origin. This transition is particularly evident among women, with breast cancer (BC) having now surpassed cervical cancer (CC) as the most common female cancer in Brazil (estimated number of incident cases in 2012: ~67,000 BC vs. ~18,000 CC). The Sistema Único de Saude (SUS) was established by the Brazilian government in 1988 to provide universal free access to health care. In 1999-2002 guidelines were issued for women aged 25-59 years to undergo a gynaecological examination every 3 years, and in 2004 for mammographic screening every two years of those aged 50-64, with information systems established to manage these screening activities. SISCOLO, implemented in 1999, records information on all Pap smear requests whereas SISMAMA, established in 2009, records data on all mammograms. Despite the success of these programs, and the lower BC incidence in Brazil than in the UK (59.5/100,000 vs. 95/100,000 in 2012), BC mortality is similar (14.3/100,000 vs. 17.1/100,000, respectively) and both CC incidence and mortality remain much higher in Brazil (16.3/100,000 and 7.3/100,000, respectively) than in the UK (7.1/100,000 and 1.8/100,000, respectively). Such disproportionately higher mortality rates are likely to be related to low coverage of the population targeted by screening and late presentation. It is the aim of this Research Partnership to investigate whether this is the case, in the first instance, by creating the tools necessary to study access to early diagnosis and treatment for the two most common female cancers - BC and CC. In particular we will:1. Gain access to, and link, at a national level, SISMAMA and SISCOLO national data to Censuses, hospital and mortality records, socioeconomic surveys, and Bolsa Familia.2. Develop a multi-disciplinary conceptual framework to identify demand (e.g. socio-economic status, belief system) and supply determinants (e.g. services availability) of inequalities in health care using such comprehensive data linkage.3. Strengthen analytic capacity to deal with the methodological challenges raised by interrogating large routinely-collected datasets. These include addressing potential sources of bias affecting the linked data and the adoption of appropriate statistical methodology for examining pathways to inequalities in health care.