Regional disparities of prostate cancer mortality in Ecuador: an examination of trends and correlates from 2004 to 2019.

BACKGROUND: Prostate cancer is the leading cause of cancer death in Ecuadorian men. However, there is a lack of information regarding the evolution of prostate cancer mortality rates in Ecuador and its regions in the last few decades. OBJECTIVE: The aim of this study was to report prostate cancer mortality rates in Ecuador and its geographical areas and observe the evolution of these rates between 2004 and 2019. METHODS: An observational ecological study was conducted, analysing data for prostate cancer deaths from 2004 to 2019 in Ecuador. Age standardized mortality rates (ASMR) were calculated per 100,000 men using the world standard population with the direct method proposed by SEGI. Joinpoint regression analysis was performed to examine mortality trends. We used a Cluster Map to explore relationships among regions between 2015 and 2019. RESULTS: Ecuador reported 13,419 deaths by prostate cancer between 2004 and 2019, with the Coastal region accounting for 49.8% of the total deaths. The mean age at death was 79 years (± 10 years), 91.7% were elderly (more than 65 years old) and had primary education (53%). Deaths by prostate cancer were more frequently reported among mestizos (81.4%). There were no significant variations in these percentages in Ecuador and its regions during the study period. Carchi province had the highest mortality rate in 2005 and 2019 (> 13 deaths per 100,000). Heterogeneity in the evolution of mortality rates was reported among the provinces of Ecuador. Azuay decreased in the first few years, and then increased from 2010 to 2019, whereas Guayas and Pichincha decreased throughout the whole period. CONCLUSION: Although prostate cancer mortality rates in Ecuador have remained stable over the past few decades, there are significant disparities among the different regions. These findings suggest the need for the development of national and provincial registration measures, integrated healthcare actions, and targeted interventions to reduce the burden of prostate cancer in the Ecuadorian population.

Propuesta de análisis territorial para enfrentar la pandemia por SARS-CoV-2 basado en el perfil de neumonía e influenza en Ecuador 2016-2018 / Proposal for territorial analysis to face the SARS-CoV-2 pandemic based on the Profile of pneumonia and Influenza in Ecuador 2016-2018

Objetivo: Analizar determinantes sociodemográficos relacionados con IRAg y calcular un índice de priorización en los cantones de Ecuador para identificar áreas vulnerables para transmisión COVID-19. Diseño: Estudio observacional ecológico descriptivo. Emplazamiento: Doscientos veinticuatro cantones de Ecuador con fuentes de datos secundarios de información hospitalaria. Participantes: La unidad de medida fueron 224 cantones de Ecuador, en los cuales se analizó tasas de morbilidad y letalidad por IRAg con datos de egresos hospitalarios (2016-2018). Mediciones principales: Se estructuraron 8 variables sociodemográficas y se aplicaron pruebas correlacionales (modelo de regresión múltiple). El índice de priorización considera criterios de eficiencia, eficacia, tamaño de efecto y equidad; usando la suma para cada indicador, se calculó el puntaje de priorización. Resultados: Factores asociados con morbilidad por IRAg fueron: escolaridad, urbanización y densidad poblacional; para mortalidad fueron escolaridad y etnia (indígena) IRR:1,09 (IC95%:1,06-1,15), IRR:1,02 (IC95%:1,02-1,03) respectivamente. Con letalidad se asociaron los cantones con población mayor de 60 años (IRR:1,05 IC95%:1,03-1,07). Se obtuvo 86 cantones de alta prioridad, mayoritariamente localizados en la región sierra centro y la provincia de Morona Santiago. Conclusiones: Morbimortalidad por IRA grave en Ecuador se asoció a factores sociales y demográficos. Los ejercicios de priorización que consideran estos factores permiten identificar territorios vulnerables durante la propagación de enfermedades respiratorias. Determinantes sociales propios de cada territorio deben sumarse a factores individuales conocidos, para analizar riesgo y vulnerabilidad por COVID.(AU)

Objective: The present study seeks to analyse sociodemographic determinants related to severe acute respiratory infections (SARI) and calculate the priorization index in the cantons of Ecuador to identify areas probably most vulnerable to COVID-19 transmission. Design: This descriptive ecological observational study. Setting: 224 cantons (geographical area) of Ecuador with secondary data sources of hospital information. Participants: The unit of measurement was 224 cantons of Ecuador, in which analysed morbidity and lethality rates for SARI using hospital release data (2016-2018). Main measurements: Eight sociodemographic indicators were structuralized, and correlation tests applied for a multiple regression model. The priorization index was created with criteria of efficiency, efficacy, effect size (IRR) and equity. Using the sum of the index for each indicator, the priorization score was calculated and localized in a territorial map. Results: Morbidity associated factors where: school attendance years, urbanization and population density; for mortality resulted: school attendance and ethnics (indigenous) IRR: 1.09 (IC95%:1.06-1.15) and IRR: 1.024 (IC95%:102-1.03) respectively. With lethality where related cantons, with population older than 60 years, IRR: 1.049 (IC95%: 1.03-1.07); 87 cantons had high priority mostly localized in the mountain region and the Morona Santiago Province. Conclusions: Morbidity and mortality of SARI in Ecuador are associated to social and demographic factors. Priorization exercises considering these factors permit the identification of vulnerable territories facing respiratory disease propagation. The social determinants characteristic for each territory should be added to known individual factors to analyse the risk and vulnerability for COVID in the population.(AU)

[Proposal for territorial analysis to face the SARS-CoV-2 pandemic based on the Profile of pneumonia and Influenza in Ecuador 2016-2018]. / Propuesta de análisis territorial para enfrentar la pandemia por SARS-CoV-2 basado en el perfil de neumonía e influenza en Ecuador 2016-2018.

OBJECTIVE: The present study seeks to analyse sociodemographic determinants related to severe acute respiratory infections (SARI) and calculate the priorization index in the cantons of Ecuador to identify areas probably most vulnerable to COVID-19 transmission. DESIGN: This descriptive ecological observational study. SETTING: 224 cantons (geographical area) of Ecuador with secondary data sources of hospital information. PARTICIPANTS: The unit of measurement was 224 cantons of Ecuador, in which analysed morbidity and lethality rates for SARI using hospital release data (2016-2018). MAIN MEASUREMENTS: Eight sociodemographic indicators were structuralized, and correlation tests applied for a multiple regression model. The priorization index was created with criteria of efficiency, efficacy, effect size (IRR) and equity. Using the sum of the index for each indicator, the priorization score was calculated and localized in a territorial map. RESULTS: Morbidity associated factors where: school attendance years, urbanization and population density; for mortality resulted: school attendance and ethnics (indigenous) IRR: 1.09 (IC95%:1.06-1.15) and IRR: 1.024 (IC95%:102-1.03) respectively. With lethality where related cantons, with population older than 60 years, IRR: 1.049 (IC95%: 1.03-1.07); 87 cantons had high priority mostly localized in the mountain region and the Morona Santiago Province. CONCLUSIONS: Morbidity and mortality of SARI in Ecuador are associated to social and demographic factors. Priorization exercises considering these factors permit the identification of vulnerable territories facing respiratory disease propagation. The social determinants characteristic for each territory should be added to known individual factors to analyse the risk and vulnerability for COVID in the population.