ESPACIALIZAÇÃO, TENDÊNCIA TEMPORAL E FATORES ASSOCIADOS À MORTALIDADE FEMININA POR CÂNCER DE MAMA NA AMAZÔNIA LEGAL

Abstract

Objective: To analyze the spatial dynamics, temporal trends, and factors associated with female mortality from breast cancer in the Brazilian Legal Amazon. Method: This is an ecological study on breast cancer mortality among women aged 20 years or older. Records of deaths occurring in the Legal Amazon between 2014 and 2023 were included, collected from January to May 2025. The data sources were: TABNET/DATASUS, Brazilian Institute of Geography and Statistics, Atlas of Human Development in Brazil, and IPS Brazil. Mortality rates were standardized using the direct method (SMR), based on the female population from the 2022 demographic census, with correction for ill-defined causes. The ecological units for temporal analysis were the states, and for spatial analysis, the health regions (HR). Temporal trends in sociodemographic characteristics and SMR were assessed using Joinpoint Regression, estimating Annual Percent Change (APC). Spatial analysis was performed using Global Moran’s Index, Local Moran’s Index (LISA Map), and spacetime scan statistics. The association between the dependent variable (SMR) and socioeconomic and healthcare indicators, based on the Social Determinants of Health (SDH) framework, was assessed through multivariate linear regression (OLS), Spatial Error Model (SEM), and Spatial Lag Model (SAR). Results: A total of 12,034 deaths were recorded during the study period. The average SMR for the Legal Amazon was 18.6 per 100,000 women, with the highest rates observed in Mato Grosso (SMR=21.7), Amazonas (SMR=21.4), and Roraima (SMR=20.3). An increasing trend was observed in the Legal Amazon (APC=2.17), Maranhão (APC=1.85), and Roraima (APC=9.97), as well as among the following groups: women aged ≥80 years, with 8 or more years of schooling, separated, and Black women after 2020. Conversely, declining trends were identified among women aged 30–39 years from 2018 onward, and among those aged 40–49 years, with 0–3 years of schooling and married. Significant spatial autocorrelation was found (I=0.218; p=0.002), and local analysis indicated “High-High” clusters in Mato Grosso, “Low-Low” clusters in Maranhão, Pará, and Amazonas, and outliers in areas of epidemiological transition. The space-time scan identified 10 clusters, including 4 protective clusters in Maranhão, Tocantins, Pará, Roraima, Amazonas, and Acre, and 6 risk clusters in Mato Grosso, Roraima, Amazonas, and Pará. Positive associations of SMR were found with aging rate (β=0.899), household per capita income (β=0.022), and number of nurses (β=0.004), while an inverse effect was observed for expected years of schooling (β=-2.101). Conclusion: The geographic and temporal disparities identified in mortality patterns underscore the relevance of SDH and highlight the need for more targeted public policies aimed at improving access to healthcare services.