Inês Afonso Gomes

An online cross-sectional study on COVID-19 vaccination adhesion was conducted in Portugal nine months after vaccination rollout (September–November 2021). Logistic regression was used to identify factors associated with hesitancy to take the COVID-19 vaccine in the community-based survey, “COVID-19 Barometer: Social Opinion”. Hesitancy was 11%; however, of those, 60.5% stated that they intended to take the vaccine. Hesitancy was associated with factors such as lower monthly household income; no intention of taking the flu vaccine this year; perceived reasonable health status; having two or more diseases; low confidence in the health service response; worse perception of the adequacy of anti-COVID-19 government measures; low or no perceived risk of getting COVID-19; feeling agitated, anxious or sad some days; and lack of trust in the safety and efficacy of the vaccines. Confidence in vaccines, namely against COVID-19, is paramount for public health and should be monitored during vaccination rollout. Clear communication of the risks and benefits of vaccination needs improvement to increase adherence and public confidence.

Introduction: Breast cancer (BC) is the most common cancer among Portuguese women and it is associated with high hospitalization rates. Therefore, this study aims to characterize the BC hospital admission rate (HAR) in women in the period of 2002–2016, with an additional focus on spatiotemporal patterns of hospitalizations by BC (main code). Methods: After a descriptive analysis of all BC hospitalizations, the main BC code HAR was studied using mapping techniques, analysis of spatiotemporal clusters, and analysis of spatial variations in temporal trends. Results: The BC-HAR was 118.72/10⁵ women, showing a growth of 3.109% per year in this period. The median length of stay (LOS) in these patients was 5 days, and most cases were programmed surgical admissions. Several spatiotemporal clusters and spatial variations in temporal trends were detected. The seaside area of the country showed 4 high HAR clusters in the spatiotemporal analysis. Additionally, the seaside north of the country and 2 isolated counties presented significantly different temporal trends in BC-HAR versus the rest of the country. These clusters suggest regional asymmetries, as they showed differences in terms of: demographic characteristics (age at admission and rurality of county of residence), the type of admission, LOS, and outcomes of hospitalization. Conclusion: This study identified key areas of high BC-HAR and increasing trends for female HAR, providing evidence of spatial heterogeneities in this health indicator.

Analysis of the Breast Cancer Mortality Rate in Portugal Over a Decade: Spatiotemporal Clustering Analysis

Breast cancer (BC) is the most frequent malignancy in Portuguese women, and more than half of the registered cases live in the south of the country. The main of this study was to characterize patients with locoregional and metastatic incident BC living in the Southern Portuguese and Madeira regions in 2005–2012 according to demographic, clinical and contextual characteristics. Additionally it aimns to find the associations and relative influences of these factors with locoregional or metastatic disease at diagnosis. After a descriptive approach, binary logistic regression models were used to estimate factors related to the presence of metastatic disease at diagnosis. A final multiple regression model was developed and presented graphically as a nomogram. The median age at diagnosis was 60.84 years, being statistically lower in locoregional cases (P<0.001). Most patients presented a locoregional disease (78.4%) of unspecified location (44.5%) and had a ductal carcinoma (73.1%). The Lisbon region represented 50.5% of the analyzed cases. Metastatic disease significantly decreased over the period under analysis (≈7%/year). Demographic (age at diagnosis ≥50 years), clinical (lobular and ‘other’ morphologies, unspecified location) and contextual (residence in Portalegre) characteristics were statistically correlated with the presence of metastatic disease at the time of BC diagnosis in univariate logistic regression, with all but the last maintaining their significance in a multivariate model. Cases with metastatic BC disease at diagnosis are decreasing; however, additional information on their characteristics can improve the alignment of public health strategies, thus strengthening this trend, and contributing to the development of a graphically tailored screening tool.

Aim: To compare the overall survival (OS) of patients with locoregional and metastatic breast cancer (BC) considering baseline demographic, clinical and contextual characteristics. Materials and Methods: A retrospective analysis of a cancer registry was conducted, using the Kaplan–Meier and Mantel–Cox analyses for the calculation of median OS and cumulative survival. Results: The median OS was 112 months, being longer in patients with locoregional versus those with metastatic BC at diagnosis (115 vs. 31 months, p<0.001). The cumulative survival at 1, 3 and 5 years were 94.9%, 85.6% and 76.5%, respectively. More recent year of diagnosis [hazard ratio (HR)=1.09] and age at diagnosis (≥65 vs. 40 years, HR=2.79) and presence of metastatic disease (HR=5.69) were associated with a shorter OS. The region of residence, morphology and topography of the tumor were also associated with survival in patients with BC. Rurality was only associated with lower survival in patients with metastatic BC. Conclusion: This study identified significant differences in the median OS of patients with locoregional and those with metastatic BC considering their baseline characteristics.

Aim: To characterize the spatiotemporal patterns of breast cancer (BC) incidence in females in the area with the highest incidence rate (IR) of the country in 2005-2012. Materials and Methods: The BC-IR was studied using mapping techniques, analysis of spatiotemporal clusters and analysis of spatial variations in temporal trends. Results: The overall BC-IR was 119.13/10⁵ inhabitants. The annual BC-IRs were 17.7, 156.9, 213.3 and 232.9/10⁵ inhabitants for women diagnosed at 5 inhabitants, increasing by 6.976 and 0.303%/year, respectively. Several spatiotemporal clusters and two spatial-variations in temporal trends were detected. The Lisbon region showed high IR clusters for most groups. Conclusion: This study identified critical areas of high IR and increasing trends for female BC-IR, providing evidence of heterogeneities in this area.