Inequalities in mammograms and cervical biopsies provision in the public and private sectors of the Brazilian healthcare system and the availability of gynecology and obstetrics specialists

IF 2.4 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Clinics Pub Date : 2026-01-01 Epub Date: 2026-03-04 DOI:10.1016/j.clinsp.2026.100876

Ivan Wilson Hossni Dias , Edmund Chada Baracat , Alicia Matijasevich , César Eduardo Fernandes , Cristiane de Jesus Almeida , Paola Soledad Mosquera , Mário César Scheffer

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引用次数: 0

Abstract

Background

This study aimed to evaluate the provision of mammograms and cervical biopsies in Brazil’s public and private healthcare sectors and the availability of gynecologists and obstetricians.

Methods

This ecological study included specialists in gynecology and obstetrics, as well as data on mammograms and cervical biopsy procedures performed in 2024 through the Brazilian Unified Health System (SUS) and private health insurance plans. For each state, ratios of specialist availability and the rate of procedures per 100,000 women were calculated. Sensitivity analysis was performed to calculate the ratio of procedures in women of different age groups, and Spearman’s correlation coefficient was used to assess the association between specialist availability and the rate of procedures performed.

Results

In 2024, health insurance plans performed 15,510.88 mammograms per 100,000 women, almost triple the SUS rate (5,733.93). The private sector performed 426.28 cervical biopsies per 100,000 women, while the public sector conducted only 85.24. The total provision of mammograms varied from 12,691.29 per 100,000 women in São Paulo to 2,702.91 in Pará. For cervical biopsies, the provision ranged from 348.94 per 100,000 women in São Paulo to 21.18 in Roraima. Correlation analysis showed a positive association between specialist availability and procedure volume (mammograms: r = 0.74; biopsies: r = 0.39; p < 0.001), which remained consistent after sensitivity analysis.

Conclusion

Separate indicators for procedure provision and specialist availability effectively identified regional disparities. These findings can guide policymakers in reducing inequalities in access to early breast and cervical cancer diagnosis.

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巴西卫生保健系统公共和私营部门提供乳房x光检查和宫颈活检方面的不平等，以及妇产科专家的可用性。

背景：本研究旨在评估巴西公共和私人医疗保健部门提供乳房x光检查和宫颈活检，以及妇产科医生的可用性。方法：这项生态研究包括妇科和产科专家，以及通过巴西统一卫生系统（SUS）和私人健康保险计划在2024年进行的乳房x光检查和宫颈活检程序的数据。对于每个州，计算了专家可用率和每10万名妇女的手术率。采用敏感性分析计算不同年龄组妇女的手术比例，并采用Spearman相关系数评估专家可用性与手术率之间的关系。结果：2024年，健康保险计划每10万名妇女进行15,510.88次乳房x光检查，几乎是SUS比率（5,733.93次）的三倍。私营部门每10万名妇女进行426.28次宫颈活组织检查，而公共部门仅进行85.24次。提供乳房x光检查的总人数从圣保罗的每10万名妇女12,691.29人到帕拉尔的2,702.91人不等。对于宫颈活组织检查，从圣保罗的每10万名妇女348.94人到罗赖马的21.18人不等。相关分析显示专科医生的可用性与手术量呈正相关（乳房x光检查：r = 0.74；活检：r = 0.39; p < 0.001），敏感性分析后这一结果保持一致。结论：程序提供和专家可用性的单独指标有效地识别了区域差异。这些发现可以指导决策者减少在获得乳腺癌和宫颈癌早期诊断方面的不平等。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinics 医学-医学：内科

CiteScore

4.10

自引率

3.70%

发文量

129

审稿时长

52 days

期刊介绍： CLINICS is an electronic journal that publishes peer-reviewed articles in continuous flow, of interest to clinicians and researchers in the medical sciences. CLINICS complies with the policies of funding agencies which request or require deposition of the published articles that they fund into publicly available databases. CLINICS supports the position of the International Committee of Medical Journal Editors (ICMJE) on trial registration.