Background: Lung cancer (LC) is the second most common neoplasm and the leading cause of cancer mortality worldwide. In Brazil, in 2023, it was the fourth most common malignant neoplasm and remained the most lethal. Most cases (85%) are diagnosed in advanced stages, resulting in low survival rates, a scenario influenced by inequalities and limited access to health services. Understanding patient navigation within the health system is key to organize health services to better support patients in receiving the care they need.
Objectives: Analyze the results of the linkage of several health information systems (HIS) for Rio de Janeiro Municipality (RJM) in the Brazilian Unified Health System (Sistema Único de Saúde – SUS).
Methods: Data were accessed from the Mortality Information System (SIM), the Regulation Information System at Municipality Level (SISREG), the Regulation Information System at the State Level (SER), the Hospitalization Information System (SIH), and the Outpatient Information System (SIA-APAC).
As the LC symptoms are non-specific and in Brazil there is no LC screening as a public policy, the cohort was created based on the individuals who had an ICD-10 C34 death as the main or secondary cause of death. Step 1) All individuals who met the inclusion criteria in the year 2024 in RJM in SIM were identified. Step 2) The CPF, Brazilian tax ID, an unique identifier (UID), were recovered based on the full name, date of birth, and the mother's name. Step 3) Using the UID, the individual was linked in SISREG, SER, SIH, and SIA-APAC. The linkage was developed and conducted by RJM managers. The project was approved by the ethics committee. The researchers had access only to anonymized data.
Results: A total of 1,561 LC mortalities were recorded in RJM in 2024. A total of 1,200 individuals (76.9%) had their UID recovered. The UID recovery rate was 55% among women and 44% among men, with no significant difference by sex. Non-white individuals had a higher UID recovery rate, being 2.68 times more likely to have their UID recovered than white individuals. This indicates that non-white individuals use the SUS more frequently, which aligns with existing literature on the profile of public health service utilization. Additionally, among individuals for whom the UID was recovered, 18% had 12 or more years of education, whereas among those for whom the UID was not recovered, this percentage was 47%. A total of 933 individuals were identified across at least one of the HIS, indicating a coverage of 77.8%. Of these, 692 were in the SISREG, 482 in the SER, 227 in the SIH, and 832 in SIA-APAC.
Conclusion/Implications: The linkage was feasible and enabled by the robustness of the HIS and the Universal Health Coverage in SUS, with a high percentage of UID recovered. It was evident that the individuals who are served by SUS have fewer years of education and are non-white. These results show that it is possible to link multiple HIS and that using this information can enable patient navigation, benefiting the most vulnerable population.