Trends in Hospitalization and Mortality from Cervical Cancer in Brazil Are Linked to Socioeconomic and Care Indicators

Round 1

Reviewer 1 Report (Previous Reviewer 5)

This paper provides a overview of the influence of social vulnerability on the rates of hospitalization and mortality due to cervical cancer. The study was meaningful. However, I have some questions.

1.The objective of this paper is to analyze the the influence of social vulnerability on the rates of hospitalization and mortality due to cervical cancer.However, there is no subject term “social vulnerability” in the title and keywords.

2.The English language and style need to be improved.Some sentences in the article are out of form. For example, the sentence “The profile of social vulnerability among women with cervical cancer in Brazil.” in the abstract.

3.The literature review in the introduction is inadequate and lacks “international” perspective. Are there related research and findings about the influence of social vulnerability on the rates of hospitalization and mortality in other country or region? Besides, what’s the rates of hospitalization and mortality of cervical cancer in Brazil?

4. What was the total sample size included in the analysis?

5.How was the social vulnerability measured in this study? Please introduce it clearly in the method.

6.The discussion is inadequate, which need to be revised. This paper just listed the research results in the Roraima, Spain, Canada,France and the United States, but did not discuss the further relationship. 

Author Response

Reviewer

The objective of this paper is to analyze the the influence of social vulnerability on the rates of hospitalization and mortality due to cervical cancer.However, there is no subject term “social vulnerability” in the title and keywords.

ANSWER: Putting in the title "socioeconomic and assistance indicators", it is already understood that social vulnerability will be addressed in the article.

The English language and style need to be improved.Some sentences in the article are out of form. For example, the sentence “The profile of social vulnerability among women with cervical cancer in Brazil.” in the abstract.

ANSWER: Has been revised the English language.

What was the total sample size included in the analysis?

ANSWER: All admissions for cervical cancer between January 2010 and December 2015 (109,243 admissions).

How was the social vulnerability measured in this study? Please introduce it clearly in the method.

ANSWER: The measure social vulnerability is inserted between lines 105 - 129 (IVS urban infrastructure, IVS human capital, IVS income and work).

Author Response File: Author Response.pdf

Reviewer 2 Report (New Reviewer)

This retrospective study deals with socioeconomic aspects of cervical cancer care in Brazil, a large populous country with significant cervical cancer burden. Despite the interesting presentation of relevant data, the study is particularly let down by its poor English. The Abstract suffers from hasty preparation and grammatical errors resulting in significant gaps in comprehension.

Instead of repeating commonplace world data for cervical cancer morbidity and mortality rates, it would be more productive quoting specific trends for Brazil, as those are estimated by the WHO (https://www.who.int/publications/m/item/cervical-cancer-bra-country-profile-2021), or robust data from other authorities (e.g. ICO/IARC).

The Introduction section would benefit from one or two paragraphs describing the general organization of healthcare infrastructures in Brazil in terms of cervical cancer treatment facilities, both in a national and regional level. Some information on cervical cancer prevention policies in Brazil would be also meaningful.

Both Methods and Results sections are sufficiently concise. The Discussion section is particularly under-developed; among others the authors should dedicate at least one paragraph to depict the current situation and future perspectives in primary cervical cancer prevention with the anti-HPV vaccine, which currently represents the only realistic tool towards cervical cancer elimination.

References should be updated with newer and more relevant ones.

Author Response

The writing was revised and the suggested paragraph inserted, lines 242-245.
Thanks for the suggestions.

Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report (New Reviewer)

In this version of the manuscript the clarity of the presentation has been largelly improved.

No further or pending issues are identified.

Author Response

Hi, I hope you are well.

Thank you very much for your considerations.

This manuscript is a resubmission of an earlier submission. The following is a list of the peer review reports and author responses from that submission.

Round 1

Reviewer 1 Report

The references must be revised. The are too many older than 10 years.

Reviewer 2 Report

The introduction should be expanded. The discussion should be more elaborate.

Reviewer 3 Report

none

Reviewer 4 Report

Comments

1. Brief introduction to cervical cancer and a rationale to choose this particular disease would be helpful.

2. Comparative analysis with any other disease or neoplasia, or a note in discussion would be helpful.

3. Abstract needs to be reframed to be more representative of the article than mentioning findings.

Reviewer 5 Report

This study provides an overview of hospitalization and mortality from cervical cancer 2 in the Brazilian regions. The study was meaningful.Please add the latest relevant research literature to enrich the background section.