Racial inequities in cervical cancer mortality and the role of the Bolsa Família conditional cash transfer programme: results from the 100 Million Brazilian Cohort.
retrospective_cohort · Level III
Where this comes from
- Record sourced from PubMed, PMID 42518663.
- Also identified by DOI 10.1016/j.lana.2026.101562 and PMC identifier 13382594.
- Licence recorded as CC BY.
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Abstract
Structural and institutional racism in Brazil mainly affects Black, 'Parda'(Brown/Mixed) and Indigenous women, who are less likely to receive adequate health care. We investigated the association between race and cervical cancer mortality and whether this association is attenuated by receipt of the Bolsa Família Programme (BFP). Women from the 100 Million Brazilian Cohort were linked to nationwide mortality registries (2004-2015). Self-reported race (White/Black/Parda/Asian/Indigenous women) and cervical cancer mortality (ICD10C53) were analysed using Poisson models adjusted for age, education, area of residence (rural/urban), and year of enrolment. Effect modification by BFP (yes/no) was assessed. We analysed 18,291,600 women. Cervical cancer mortality rates were greater among Indigenous (adjusted-Mortality rate ratio (aMRR) and adjusted-Mortality rate difference (aMRD): 1.78, 95% CI 1.40-2.25 and 5.26, 95% CI 2.41-8.11, respectively), Asian (aMRR = 1.55, 1.16-2.06 and aMRD = 3.72, 0.74-6.70), Parda (aMRR = 1.28, 1.22-1.34 and aMRD = 1.91, 1.56-2.25), and Black (aMRR = 1.20, 1.12-1.29 and aMRD = 1.37, 0.80-1.95) women vs. White women. Among BFP recipients, aMRR and aMRD were, respectively, 1.12 (95% CI 1.03-1.22) and 0.77 (95% CI 0.19-1.35) for Black, 1.25 (1.19-1.32) and 1.61 (1.25-1.97) for Parda, 1.74 (1.35-2.24) and 4.70 (1.94-7.47) for Indigenous, and 1.56 (1.12-2.18) and 3.57 (0.26-6.87) for Asian women vs. White women; whilst among non-BFP recipients, aMRR and aMRD were, respectively, 1.53 (95% CI 1.31-1.78) and 4.05 (95% CI 2.34-5.76) for Black, 1.36 (1.24-1.49) and 2.76 (1.94-3.59) for Parda, 1.98 (0.94-4.16) and 7.48 (-3.77 to 18.73) for Indigenous, and 1.55 (0.89-2.68) and 4.21 (-2.27 to 10.68) for Asian women vs. White women (p interaction = 0.017). Racial differentials in cervical cancer mortality were reduced among BFP recipients and heightened among non-BFP recipients. This suggests that racial inequities in cervical cancer mortality may be mitigated with BFP receipt, through cash and/or conditionalities. Possibly, by improving women's income and access to cervical cancer screening and pre-cancer treatment, ultimately reducing mortality. National Institute for Health and Care Research-NIHR, Wellcome Trust, CNPq.