Socio-spatial profiles of health transition in Argentina: exploring social inequalities in preventive practices for breast and cervical cancer.

SARMIENTO D; PEREYRA S; SCRUZZI GF; TUMAS N; POU SA

Taiwan

Conferencia; 35th Annual Conference of the International Society of Environmental Epidemiology (ISEE).; 2023

ISEE - International Society for Environmental Epidemiology

BACKGROUND AND AIM: Argentina has experienced changes (transitions) in its health system and health care, with heterogeneous impacts on women’s health. This work aimed to identify socio-spatial profiles of health transition (HT) related to preventive practices for breast and cervical cancers within Argentina.METHOD: A nationwide ecological study was performed in Argentina. Indicators of socio-sanitaryvulnerability (related to health resources, health services accessibility, and socioeconomic context)and demographic characteristics (urbanization, population structure) were selected from official data sources about 24 geographical units (2005-2018 period). Multiple Correspondence Analysis (MCA) coupled with Hierarchical Cluster Analysis was used to identify socio-spatial clusters representing HT profiles across Argentina. Mammography screening practice and Pap smear (%) in target women (aged 50-70 and 25-65, respectively) for 2018 were included as supplementary variables and exploratively projected in the graph constructed from MCA. All variables were categorized by tertiles (low/intermediate/high levels).RESULTS: High socioeconomic stratum and health insurance coverage, low infant mortality, and high rate of physicians appeared close to a high level of mamograms and Pap practices in the dimensional space produced by the MCA, indicating co-occurrence in the data set. Based on the dimensions obtained by the MCA (76% of the total explained variance), three socio-spatial profiles of HT were identified. The first profile (located in the central and southern region of Argentina) was characterized by low socio-sanitary vulnerability, high prevalence of preventive practices for breast and cervical cancer, and aging population. The second one, showed intermediate levels of socio-sanitary vulnerability and preventive practices, with high density of mammographs (per 10,000 women). The third HT profile (Northern Region), presented high socio-sanitary vulnerability and low preventive practices, with low health resources (rate of physicians, mammograph density, and health insurance coverage).CONCLUSIONS: Different HT profiles related to preventive practices of breast and cervical cancercoexist within Argentina, shaping underlying social-spatial inequalities in women's health.