Spatial distribution of timely treatment for cervical cancer: Socioeconomic inequalities and disparities in healthcare service availability in Brazil

Introduction: Cervical cancer is one of the leading causes of cancer-related death among women in countries with lower socioeconomic levels. In Brazil, it represents the third most common type of cancer and the fourth leading cause of death, excluding non-melanoma skin cancers. Delays in initiating oncologic treatment have remained frequent even after the implementation of Law No. 12,732, which mandates treatment initiation within 60 days of diagnosis. Objective: To analyze the spatial distribution of the proportion of cervical cancer cases that started treatment within 60 days after diagnosis and to assess its spatial correlation with contextual socioeconomic indicators and healthcare service availability in Brazil. Methods: Ecological study included the 133 Intermediate Regions of Urban Articulation during the post-enactment period of Law No. 12,732 (2013–2019). The dependent variable—the proportion of cases initiating treatment within 60 days—was obtained from the Integrated Cancer Hospital Registry. Socioeconomic variables were extracted from the Atlas of Human Development in Brazil, while data on medical density and health service availability were obtained from the National Registry of Health Establishments and the Outpatient Information System of the Brazilian Unified Health System. Spatial clustering was evaluated using Global Moran's I and the Local Indicator of Spatial Association. Multivariate analysis employed spatial regression models with global effects. Results: The proportion of cervical cancer cases that initiated treatment within 60 days was 40.4 % (95 % CI: 39.9 %–40.9 %). A positive spatial correlation was observed between timely treatment and cytopathological test density (p = 0.00523), while a negative correlation was found with the population aging rate (p < 0.001). Conclusion: Regions with lower population aging rates and greater availability of cytopathological exams were associated with higher compliance with the “60-day law.” These findings highlight the influence of socioeconomic context and healthcare service distribution on timely access to cervical cancer treatment.