Ethnic-racial relationships within the healthcare service for the diagnosis and treatment of oral cavity cancer in Brazil

Abstract

Introduction: The social, economic, cultural, and ethnic-racial disparities in Brazil may be related to the time it takes for healthcare services to diagnose and treat oral cavity cancer. Objective: To analyze the relationship between race/skin color and different time intervals for the diagnosis and treatment of oral cavity cancer in Brazilian health services. Method: Observational, hospital-based study with 12,421 cases retrieved from the Brazilian Hospital Cancer Registries. Ethnic-racial classification was based on the combination of color and race categories used by the Brazilian Institute of Geography and Statistics. The Wilcoxon rank-sum test, Poisson regression model, and causal mediation analysis were applied. Results: The retrieved records represented 6,523 (53%) white individuals and 5,898 (47%) non-white individuals. The groups showed heterogeneity in sociodemographic, clinical, and therapeutic variables, but were homogeneous regarding the main risk factors for the disease. Significant differences were observed in all key points analyzed (p<0.001). Non-white individuals have a longer health services interval than white individuals (median of 71 vs. 57 days, respectively), with the direct effect of race/skin color being significant (p<0.001) even when mediated by region of residence or clinical stage of the disease. Conclusion: Race/skin color has a decisive impact on waiting times in Brazilian healthcare services, where non-white individuals wait, on average, 16.2 days longer than white individuals.