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

与许多其他低收入和中等收入国家一样，巴西正在经历癌症转型，与感染有关的癌症正在被非传染性病因的癌症所取代。这种转变在女性中尤为明显，乳腺癌（BC）现在已经超过宫颈癌（CC），成为巴西最常见的女性癌症（2012年估计病例数：约67,000 BC对约18,000 CC）。巴西政府于1988年建立了Único沙特系统（SUS），目的是提供普遍免费的保健服务。在1999年至2002年期间，发布了25-59岁妇女每三年进行一次妇科检查的指南，并在2004年发布了50-64岁妇女每两年进行一次乳房x光检查的指南，并建立了管理这些检查活动的信息系统。SISCOLO于1999年实施，记录了所有子宫颈抹片检查请求的信息，而SISMAMA于2009年建立，记录了所有乳房x光检查的数据。尽管这些项目取得了成功，巴西的BC发病率低于英国（2012年为59.5/10万比95/10万），但BC死亡率相似（分别为14.3/10万比17.1/10万），巴西的CC发病率和死亡率仍然远高于英国（分别为16.3/10万和7.3/10万）（分别为7.1/10万和1.8/10万）。这种不成比例的高死亡率很可能与接受筛查的人口覆盖率低和就诊时间晚有关。该研究伙伴关系的目的是首先通过创建必要的工具来研究两种最常见的女性癌症（BC和CC）的早期诊断和治疗途径，来调查情况是否如此。2.在国家一级获取SISMAMA和SISCOLO国家数据，并将其与人口普查、医院和死亡率记录、社会经济调查和家庭津贴联系起来。2 .制定一个多学科的概念框架，利用这种全面的数据联系，确定保健不平等的需求（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，以应对通过询问常规收集的大型数据集提出的方法挑战。这些措施包括处理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.