E142: Wealth inequality in esophageal cancer treatment in Brazil

Introduction: Health care is heterogeneous throughout the world, especially in developing countries. Some patients receive cutting-edge treatment, while others have limited access to healthcare. Vulnerable populations potentially have a worse prognosis for neoplasms that require highly complex treatment, such as esophageal cancer. The objective of the present study was to identify individual and municipal characteristics of access to health, including education, use of health plans, GDP per capita (GDPpc) and urban aspects, which can impact the survival of patients with esophageal cancer.

Methods: Information on urban concentration, administrative hierarchy and GDPpc (IBGE; 2020) and on individual patient characteristics and access to healthcare (Fund. Oncocentro-FOSP; 2013-2022) in the state of São Paulo were analyzed. Municipalities that provided care to patients with esophageal neoplasia during the period were included. Only patients with adenocarcinoma or squamous cell carcinoma (SCC) were selected and those with other neoplasms or without information were excluded. Cox regressions were evaluated for the independent variables GDPpc, urban concentration, municipal administrative hierarchy, health plan, education, and individual cancer and patient characteristics in relation to overall survival (OS). Variables considered significant in the univariate model were selected for multivariate analysis.

Results: After applying eligibility criteria, 9280 patients with esophageal cancer (85% SCC; 15% Adenocarcinoma) were selected. Only 4% of patients received private and health care. In the univariate analysis, higher education (HR=0.6; SE=0.05; p< 0.001), female gender (HR=0.85; SE=0.03; p< 0.001) and private health insurance (HR=0.65; SE=0.04; p < 0.001) were considered protective factors for OS in esophageal cancer. Furthermore, stage IV, SCC, and treatment with surgery, chemotherapy, or radiotherapy had an impact on OS (p< 0.05). The variables selected for the multivariate analysis remained significant (p< 0.05).GDPpc and municipal urban concentration and hierarchy were not associated with OS.

Conclusions: Populations at risk, including those with low access to education and access to health, have a worse prognosis in esophageal cancer. Municipal GDPpc has no independent association with OS. The results of the present study are useful for control and management in population health.