Geographical provenance and clinical status upon admission of patients with gestational trophoblastic disease in a specialized referral center in the state of São Paulo, Brazil

Abstract

Background: The clinical status of patients with gestational trophoblastic disease (GTD) upon admission to specialized centers is significantly influenced by social and economic factors, as well as by barriers in access to health care providers, which are associated with advanced disease at presentation. In Brazil, a regionalization strategy has been adopted in order to facilitate access to healthcare (political-administrative healthcare districts). Objectives: To assess the clinical status upon admission in GTD patients referred to the Botucatu Trophoblastic Diseases Center (BTDC) of São Paulo State University to determine its relationship with the patient's healthcare district of origin. Methods: This cross-sectional observational study will include 410 GTD patients from health districts located across the state of São Paulo, who were referred to and then assessed at BTDC between 1990 and 2017. The clinical status upon admission of patients with hydatidiform mole (HM) or gestational trophoblastic neoplasia (GTN) will be considered as outcome variables. MH patients, clinical status will assessed according to the molar pregnancy risk score system of Berkowitz et al. (1987), while in those with GTN clinical status will be assessed using the FIGO/WHO (2002) staging and risk factor scoring system. The following variables will be considered potential confounders: age, race, parity, education level, marital status, employment status, previous knowledge of GTD. The statistical analysis of the relationship of risk score and clinical status upon admission with patient's healthcare district of origin will be performed by adjusting regression models.