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Peer-reviewedCC BY-NCInternational journal of women's health

Spatiotemporal Analysis of Hospitalisations and Mortality From Gynaecological Cancers in Ecuador, 2015-2024.

  • Karina Lalangui-Vivanco1
  • Leyda Elizabeth Jaramillo-Feijoo2
  • Jhony Joe Real-Cotto2
  • Emmanuelle Quentin1
  1. 1Centro de Investigación en Salud Pública y Epidemiología Clínica (CISPEC), Facultad Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, 170508, Ecuador.
  2. 2Departamento Gestión de la Información y Productividad. Sociedad de Lucha Contra el Cáncer del Ecuador (SOLCA), Guayaquil, 090505, Ecuador.
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Abstract

Purpose

To analyse the spatiotemporal patterns of hospitalisations and mortality due to gynaecological cancers in Ecuador (2015-2024), identify provincial geographic disparities, and examine the association between healthcare infrastructure and clustering patterns.Methods

This population-based ecological study used INEC hospital discharge and general death records for women with gynaecological cancers (ICD-10: C51-C57) in Ecuador from 2015 to 2024. Age-standardised rates per 100,000 women were calculated by year, cause, age group, and province of residence. K-means clustering was applied separately to hospitalisation and mortality rates to identify provinces with similar temporal trajectories. Global and local Moran's I assessed spatial autocorrelation, and Spearman correlations and Kruskal-Wallis tests examined associations with healthcare infrastructure.Results

Between 2015 and 2024, 39,492 hospitalisations and 11,410 deaths were recorded. Cervical cancer accounted for 45.4% of hospitalisations and 42.2% of deaths, followed by ovarian cancer (32.6% and 22.0%). Hospitalisations declined markedly in 2020 during the COVID-19 pandemic. Trajectory-based k-means identified three clusters for each outcome. The highest hospitalisation rates were concentrated in the southern provinces, with significant global spatial autocorrelation (Moran's I = 0.48-0.64, all p ≤ 0.002) and a persistent High-High spatial cluster, while the highest mortality occurred in the northern and central Sierra and the Amazon, without consistent spatial autocorrelation. Nine provinces had high mortality, low hospitalisation, and lower bed density (224.9 vs 260.1 per 100,000 women). Bed density was not significantly correlated with hospitalisation (rho = 0.35, p = 0.097) or mortality (rho = -0.27, p = 0.205); bed density did not differ across mortality clusters (p = 0.52).Conclusion

The mismatch between hospitalisation and mortality clustering patterns, together with lower healthcare infrastructure in high-mortality provinces, suggests that unequal access to timely care may contribute to excess mortality, although these associations were not statistically significant.

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Cite

BibTeXRIS
BibTeX
@article{lalanguivivanco2026spatiotemporal,
  title = {{Spatiotemporal Analysis of Hospitalisations and Mortality From Gynaecological Cancers in Ecuador, 2015-2024.}},
  author = {Karina Lalangui-Vivanco and Leyda Elizabeth Jaramillo-Feijoo and Jhony Joe Real-Cotto and Emmanuelle Quentin},
  journal = {International journal of women's health},
  year = {2026},
  month = oct,
  doi = {10.2147/ijwh.s624869},
  url = {https://europepmc.org/article/MED/42904145},
  note = {CC BY-NC},
}
RIS
TY  - JOUR
TI  - Spatiotemporal Analysis of Hospitalisations and Mortality From Gynaecological Cancers in Ecuador, 2015-2024.
AU  - Karina Lalangui-Vivanco
AU  - Leyda Elizabeth Jaramillo-Feijoo
AU  - Jhony Joe Real-Cotto
AU  - Emmanuelle Quentin
PY  - 2026
DA  - 2026/10/16
JO  - International journal of women's health
DO  - 10.2147/ijwh.s624869
UR  - https://europepmc.org/article/MED/42904145
AB  - Purpose  To analyse the spatiotemporal patterns of hospitalisations and mortality due to gynaecological cancers in Ecuador (2015-2024), identify provincial geographic disparities, and examine the association between healthcare infrastructure and clustering patterns.Methods  This population-based ecological study used INEC hospital discharge and general death records for women with gynaecological cancers (ICD-10: C51-C57) in Ecuador from 2015 to 2024. Age-standardised rates per 100,000 women were calculated by year, cause, age group, and province of residence. K-means clustering was applied separately to hospitalisation and mortality rates to identify provinces with similar temporal trajectories. Global and local Moran's I assessed spatial autocorrelation, and Spearman correlations and Kruskal-Wallis tests examined associations with healthcare infrastructure.Results  Between 2015 and 2024, 39,492 hospitalisations and 11,410 deaths were recorded. Cervical cancer accounted for 45.4% of hospitalisations and 42.2% of deaths, followed by ovarian cancer (32.6% and 22.0%). Hospitalisations declined markedly in 2020 during the COVID-19 pandemic. Trajectory-based k-means identified three clusters for each outcome. The highest hospitalisation rates were concentrated in the southern provinces, with significant global spatial autocorrelation (Moran's I = 0.48-0.64, all p ≤ 0.002) and a persistent High-High spatial cluster, while the highest mortality occurred in the northern and central Sierra and the Amazon, without consistent spatial autocorrelation. Nine provinces had high mortality, low hospitalisation, and lower bed density (224.9 vs 260.1 per 100,000 women). Bed density was not significantly correlated with hospitalisation (rho = 0.35, p = 0.097) or mortality (rho = -0.27, p = 0.205); bed density did not differ across mortality clusters (p = 0.52).Conclusion  The mismatch between hospitalisation and mortality clustering patterns, together with lower healthcare infrastructure in high-mortality provinces, suggests that unequal access to timely care may contribute to excess mortality, although these associations were not statistically significant.
SN  - 1179-1411
ER  -