Programa bolsa família, política nacional de saúde bucal e mortalidade por câncer de boca no Brasil

Abstract

Objective: To go through the relationship between the implementation of the National Oral Health Policy (PNSB) and mortality rates from mouth cancer, estimating future trends and understanding the association between the Bolsa Família Program (PBF) and mortality rates from mouth cancer. Materials and Methods: This one is quite an ecological study with secondary data from deaths caused by mouth cancer obtained from the Mortality Information System. Plus, the outcome for both articles was the mortality rate due to oral cancer, standardized by gender and age, collected from IBGE, per 100,000 inhabitants. In addition, regarding the first article, the Autoregressive Integrated Moving Average (ARIMA) was used during the years 1996 to 2019. Regarding the second one, deaths caused by mouth cancer from 2005 to 2017 were included. The analysis units of the referred thesis were federative units as well as the Brazilian macro-regions. Furthermore, the exogenous variable included in the time series analysis of the first article was the PNSB, classified as "yes" from 2005. The modeling Box and Jenkins, ARIMA (time analysis, trend prediction with a 5-year horizon and estimation of the regression coefficient - CR) was considered. The independent variable of the second article is the coverage of the PBF, calculated as the ratio between the number of families receiving the benefit and those which should potentially receive it. The covariates included in the model were socioeconomic and health service coverage. What’s more, coroplethic maps and Space Time Cube analysis were made to analyze the space-time distribution of PBF coverage and mortality rates due to mouth cancer between 2005 and 2017. Linear regression analysis with mixed effects with random interception was used, estimating angular coefficients () and respective Confidence Intervals of 95% (95% CI) (=0.05). Results: The global and southern mortality rates have shown a stationary trend; while the rates in other regions required 1 differentiation in the treatment of the time series. The prediction models estimated an increase in those for the North and Northeast regions, a decrease for the Southeast and the stability of the rates predicted for Brazil and the South region. The implementation of the PNSB has contributed to the increase in the mortality rate due to oral cancer in the Northeast Region (CR=0.854677; p=6.642.10-6), meanwhile, for the other macro-regions and for Brazil, the inclusion of this exogenous variable in the model had no effect. In the second article, there was a trend of increase in PBF coverage and stability for the mortality rate for the federative units, except Maranhão, Goiás and Minas Gerais. In the adjusted analysis, the highest coverage of the PBF was associated with lower mortality rates from oral cancer (:-2.10; IC95%: -3,291 -0.9185). Conclusion: In view of the products carried out by this thesis, it is possible to conclude that the trends of the observed and predicted rates presented different behaviors in the Brazilian territory and the implementation of the PNSB has not yet resulted in a decrease in mortality from oral cancer, while the PBF contributes to the decrease of the outcome studied, therefore it can be recommended the expansion and implementation of social and health policies with a view to preventing avoidable deaths from this disease.