Inequidades en salud: an?lisis sociodemogr?fico y espacial del c?ncer de mama en mujeres de C?rdoba, Argentina / Inequities in health: socio-demographic and spatial analysis of breast cancer in women from C?rdoba, Argentina

Resumen Objetivo: Identificar determinantes sociodemogr?ficos asociados a la distribuci?n espacial de la incidencia de c?ncer de mama en la provincia de C?rdoba, Argentina, a fin de develar inequidades sociales en salud. M?todo: Se desarroll? un estudio ecol?gico en C?rdoba (26 departamentos como unidades geogr?ficas de an?lisis). Mediante el ?ndice de Moran se estim? la autocorrelaci?n espacial de las tasas de incidencia de c?ncer de mama, brutas y estandarizadas, y de indicadores sociodemogr?ficos de urbanizaci?n, fecundidad y envejecimiento poblacional. Estas variables fueron incorporadas a a un Sistema de Informaci?n Geogr?fica para su mapeo. Se ajustaron modelos de regresi?n de Poisson multinivel, para la tasa de incidencia de c?ncer de mama como variable respuesta, indicadores sociodemogr?ficos seleccionados como covariables, y porcentaje de hogares con necesidades b?sicas insatisfechas como variable de ajuste. Resultados: En C?rdoba, Argentina, existe un patr?n no aleatorio en las distribuciones espaciales de las tasas de incidencia de c?ncer de mama y de ciertos indicadores sociodemogr?ficos. El incremento medio anual de la poblaci?n urbana fue inversamente asociado a la ocurrencia de c?ncer de mama, mientras que la proporci?n de hogares con necesidades b?sicas insatisfechas present? una asociaci?n directa. Conclusiones: Nuestros resultados definen escenarios de inequidad social que explican, en parte, los diferenciales geogr?ficos de la carga del c?ncer de mama en C?rdoba, Argentina. Las mujeres residentes en hogares socioecon?micamente desfavorecidos y en ?reas menos urbanizadas requieren especial atenci?n en futuros estudios e intervenciones de salud p?blica en c?ncer de mama. / Objective: To identify sociodemographic determinants associated with the spatial distribution of the breast cancer incidence in the province of C?rdoba, Argentina, in order to reveal underlying social inequities. Method: An ecological study was developed in C?rdoba (26 counties as geographical units of analysis). The spatial autocorrelation of the crude and standardised incidence rates of breast cancer, and the sociodemographic indicators of urbanization, fertility and population ageing were estimated using Moran's index. These variables were entered into a Geographic Information System for mapping. Poisson multilevel regression models were adjusted, establishing the breast cancer incidence rates as the response variable, and by selecting sociodemographic indicators as covariables and the percentage of households with unmet basic needs as adjustment variables. Results: In C?rdoba, Argentina, a non-random pattern in the spatial distribution of breast cancer incidence rates and in certain sociodemographic indicators was found. The mean increase in annual urban population was inversely associated with breast cancer, whereas the proportion of households with unmet basic needs was directly associated with this cancer. Conclusions: Our results define social inequity scenarios that partially explain the geographical differentials in the breast cancer burden in C?rdoba, Argentina. Women residing in socioeconomically disadvantaged households and in less urbanized areas merit special attention in future studies and in breast cancer public health activities.