Universal Health Coverage and Education Are the Decisive Socio-Economic Disparities in Cervical Cancer Mortality in the Dominican Republic: A Multi-Dimensional Ecological Approach in a Middle-Income Caribbean Country

OBJECTIVES: Cervical cancer is one of the cancers with the highest frequency and premature deaths among women in the world, especially in low- and middle-income countries where preventive strategies are often lacking such as the Dominican Republic. We analyzed the multi-dimensional magnitude of socio-economics disparities in cervical cancer mortality outcome in the 2016.

METHODS: Ecological study using disaggregated data on cervical cancer deaths based on a population-based cancer registry matched with public domain socio-economic indicators for each province aggregated data. The Dominican Republic as a Caribbean region country with 11.5 million of people, politically divided in provinces, Santo Domingo with 50¬% of total population and other 30 provinces, we calculated Cervical Cancer Mortality Rate by province and ranked according to socio-economic status. The socio-economic disparities were estimated based on the magnitude of disparities using gradient measures of absolute and relative inequalities. A multi-dimensional approach of measures of disparities based on linear regression of cervical cancer mortality between provinces according to socio-economic determinants were performed.

RESULTS: Women with not health-insurance coverage and unlettered showed the greatest socio-economic inequalities. Classifying the provinces by quintiles, a difference between provinces Q5-Q1 of -31.32% for illiteracy and -35.72% for the population not affiliated with health insurance. The absolute disparity according to illiteracy show three times more deaths due to cervical cancer per 100,000 women-years in the provinces with the worst socio-economic status; 50% of cervical cancer deaths were concentrated in the poorest 40% of the country population.

CONCLUSIONS: The Dominican Republic faces a marked socioeconomic inequality in cervical cancer mortality essentially related to the illiteracy, limited access to health insurance coverage and multidimensional poverty. An urgent need to strengthen access to health insurance and key information systems a such as population-based cancer registry for an effective orientation of interventions that allow narrowing the cancer women inequality gap.