Disparities in female breast cancer mortality rates between urban centers and rural areas of Brazil: Ecological time-series study

Objectives: To evaluate trends in breast cancer mortality in urban centers and rural areas of Brazil. Methods: Ecological time-series study using data on breast cancer deaths and census. Mortality trends were analyzed using change-point regression: 1980-2010. Results: A declining trend was found in five urban centers: Sao Paulo (APC = - 1.7%), Porto Alegre (APC = = 1.6%), Belo Horizonte (APC = - 1.2%), Rio de Janeiro and Recife (APC = - 0.9%). An increasing was found in: Porto Velho (APC = 9.0%), Teresina (APC = 4.6%), Joao Pessoa (APC = 1.6%), Belem (APC = 0.8%) and Fortaleza (APC = 0.5%). In the majority of rural areas, mortality continues to rise, with the exception of some areas in the southern. Conclusion: Disparities in breast cancer mortality were found across the country, with increasing trends occurring predominantly in the north and northeastern regions. One of the reasons for this disparity may be that access to treatment is more difficult for patients living in rural areas and in the north of Brazil. (C) 2014 Elsevier Ltd. All rights reserved.