ABSTRACT
An online cross-sectional study on COVID-19 vaccination adhesion was conducted in Portugal nine months after vaccination rollout (September-November 2021). Logistic regression was used to identify factors associated with hesitancy to take the COVID-19 vaccine in the community-based survey, "COVID-19 Barometer: Social Opinion". Hesitancy was 11%; however, of those, 60.5% stated that they intended to take the vaccine. Hesitancy was associated with factors such as lower monthly household income; no intention of taking the flu vaccine this year; perceived reasonable health status; having two or more diseases; low confidence in the health service response; worse perception of the adequacy of anti-COVID-19 government measures; low or no perceived risk of getting COVID-19; feeling agitated, anxious or sad some days; and lack of trust in the safety and efficacy of the vaccines. Confidence in vaccines, namely against COVID-19, is paramount for public health and should be monitored during vaccination rollout. Clear communication of the risks and benefits of vaccination needs improvement to increase adherence and public confidence.
ABSTRACT
INTRODUCTION: Breast cancer is the first cause of cancer-related death in Portuguese women. This study aimed to characterize female breast cancer mortality in Portugal in the period between 2002 and 2013, with a special focus on spatiotemporal patterns. MATERIAL AND METHODS: The breast cancer mortality rate was studied using descriptive analysis (unadjusted and age-adjusted), and spatiotemporal clustering analyses. RESULTS: In 2002 - 2013 the breast cancer mortality rate was 28.47/100 000 inhabitants and the age-adjusted mortality rate was 19.46/100 000 inhabitants. In this period the Lisbon region (urban), Alentejo and Algarve (rural) presented higher breast cancer mortality rate, but Madeira (urban), Lisbon and Algarve had higher age-adjusted mortality rate. In the spatiotemporal analysis, the overall mortality rate showed an increasing trend of 1.218%/year, without spatial variations. Also, different patterns were detected in the < 50, 50 - 64 and ≥ 65 age-groups (+ 0.725%, - 1.781% and + 0.896%, respectively). One temporal (2004 - 2006) and one spatiotemporal cluster (North coast) presented significantly lower mortality rate than expected for the period and/or area (26.2 and 16.1/100 000 inhabitants, respectively). Conversely, two spatiotemporal clusters, located in the city of Lisbon (2002 - 2007) and in the Centre region (2008 - 2013), presented significantly higher breast cancer mortality rate than expected (48.6 and 34.9/100 000 inhabitants, relative risk: 1.74 and 1.26, respectively). DISCUSSION: The annual female crude and adjusted breast cancer mortality rate matched previous publications. However the annual increase detected in the unadjusted rate clashes with the published literature. Overall, the presence of spatiotemporal clusters supports the uneven distribution of the breast cancer mortality reported previously in the different Portuguese regions. CONCLUSION: This study identified areas and trends of the female breast cancer mortality rate, showing high spatiotemporal variations that must support further detailed studies/interventions.
Introdução: O cancro da mama é a primeira causa de morte relacionada com cancro em mulheres portuguesas. Este estudo pretende caracterizar a mortalidade feminina por cancro da mama em Portugal no período de 2002 a 2013, com enfoque nos padrões espácio-temporais. Material e Métodos: A taxa de mortalidade por cancro da mama foi estudada com recurso a análise descritiva (bruta e ajustada para a idade), e análise de clustering espácio-temporal. Resultados: Em 2002 2013 a taxa de mortalidade por cancro da mama foi 28,47/100 000 habitantes e a taxa de mortalidade ajustada pela idade foi de 19,46/100 000 habitantes. Neste período a região de Lisboa (urbana), Alentejo e Algarve (rural) apresentaram taxas de mortalidade mais elevadas, mas após ajustamento pela idade a Madeira (urbana), Lisboa e Algarve demonstraram taxas de mortalidade superiores. Na análise espácio-temporal, a taxa de mortalidade geral apresentou um crescimento de 1,218%/ano, sem variações espaciais. Adicionalmente, padrões diferentes foram detetados nos grupos de mulheres com < 50, 50 - 64 e ≥ 65 anos (+ 0,725%, - 1,781% e + 0,896%, respetivamente). Um cluster temporal (2004 2006) e um espácio-temporal (costa Norte) apresentaram taxa de mortalidade significativamente mais baixas que o esperado para o período e/ou área (26,2 e16,1/100 000 habitantes, respetivamente). Por outro lado, dois clusters espácio-temporais, localizados na cidade de Lisboa (2002 2007) e na zona Centro (2008 2013), apresentaram taxas de mortalidade por cancro da mama superiores às expectáveis (48,6 e 34,9/100 000 habitantes, risco relativo: 1,74 e 1,26, respetivamente). Discussão: A taxa anual bruta e ajustada para a idade de mortalidade por cancro da mama aproximam-se das anteriormente publicadas. No entanto, o aumento anual nas taxas brutas contrasta com a literatura neste tópico. A presença de clusters espácio-temporais suporta a distribuição variável da taxa de mortalidade por cancro da mama nas diferentes regiões do país. Conclusão: Este estudo identificou áreas e tendências na taxa de mortalidade feminina por cancro da mama, demonstrando variações espácio-temporais nesta taxa que suportam estudos e intervenções mais detalhadas nesta área.
