Mortality from Malignant Diseases in a Saudi Population in the Asir Region: A Four-Year Review

Abstract

Brief ReportMortality from Malignant Diseases in a Saudi Population in the Asir Region: A Four-Year Review Mohammad Y. Alshehri, FRCSC, FACS Oluwole Ajao, and FRCS, FACS Mostafa A. AbolfotouhMD, DrPH Mohammad Y. Alshehri Search for more papers by this author , Oluwole Ajao Search for more papers by this author , and Mostafa A. Abolfotouh Search for more papers by this author Published Online:1 May 2001https://doi.org/10.5144/0256-4947.2001.248SectionsPDF ToolsAdd to favoritesDownload citationTrack citations ShareShare onFacebookTwitterLinked InRedditEmail AboutIntroductionThe aim of this study was to determine the causes of mortality from different malignancies in the Asir region of Saudi Arabia. The Asir region is an area of about 80,000 km2, with a population of about 1.2 million people.1 Asir Central Hospital is the main referral hospital, and serves as the teaching hospital of the medical school in the region. All complicated and terminal cases from the 17 hospitals in the region are routinely referred to this hospital. As such, deaths from malignant conditions at the hospital provide a fair reflection of such deaths in this area. We decided, therefore, to study the causes of death from malignant conditions in a four-year period so as to identify the main malignant killers in the region.Patients and MethodsIn this descriptive study, all intrahospital deaths from various forms of malignant conditions recorded by the hospital over a four-year period (n=237) were studied. This period extended from June 1991 to May 1995. The International Classification of Diseases for Oncology (ICD-O) 1990 was used to classify the main causes of deaths. Data were analyzed using the EPI Info Software program for tabulation and computation. Pearson chi-squared test was applied (with Yates correction when needed) to compare the different proportions of causes of death.ResultsLiver cancer ranked first as the major cause of death from malignancy at Asir Central Hospital, representing 23.6% of all causes, followed by lymphoma and leukemia (10.1% each), cancer of the pancreas (9.7%), brain tumor (7.6%), stomach cancer (5.5%), and cancers of the esophagus and lung (5.1% each) (Table 1).Table 1 Frequency (%) of deaths from different malignancies at Asir Central Hospital and their rank order during the years 1991–1995.(n=237)Type of malignancyNo. (%)Rank orderHepatoma56 (23.6)1Lymphoma24 (10.1)2.5Leukemia24 (10.1)2.5Pancreatic cancer23 (9.7)4Brain tumor18 (7.6)5Gastric cancer13 (5.5)6Esophageal cancer12 (5.1)7.5Lung cancer12 (5.1)7.5Cholangiocarcinoma9 (3.8)9Breast cancer8 (3.4)10Colorectal cancer7 (3.0)11Others (bladder, thyroid, cervix, prostate, etc.)31 (13.1)As regards sex (Table 2), hepatoma was the leading cause of death among males, constituting a significantly higher frequency than that among females (31.5% vs. 11.0%, P=0.0003). This was followed in descending order in males by lymphoma (11.0%), leukemia and brain tumors (8.2% each), gastric cancer (6.8%), and cancer of the pancreas and lungs (5.5% each). On the other hand, cancer of the pancreas ranked first among females, with a significantly higher frequency of deaths (16.5%) than that among males (5.5%) (P=0.005). This was followed in descending order by leukemia (13.2%), hepatoma (11.0%), lymphoma and cancer of the breast (8.8% each), brain tumors and cancer of the esophagus (6.6% each).Table 2 Frequency (%) of deaths from different malignancies at Asir Central Hospital and their rank order by sex during the years 1991–1995.Type of malignancyMale (n=146)Female (n=91)P*No. (%)Rank orderNo. (%)Rank orderHepatoma46 (31.5)110 (11.0)30.0003**Lymphoma16 (11.0)28 (8.8)4.50.59Leukemia12 (8.2)3.512 (13.2)20.22Pancreatic cancer8 (5.5)6.515 (16.5)10.005**Brain tumor12 (8.2)3.56 (6.6)6.50.65Gastric cancer10 (6.8)53 (3.3)9.50.31Esophageal cancer6 (4.1)96 (6.6)6.50.49Lung cancer8 (5.5)6.54 (4.4)80.81Cholangiocarcinoma7 (4.8)82 (2.2)110.41Breast cancer––8 (8.8)4.50.001**Colorectal cancer4 (2.7)103 (3.3)9.50.88Others (bladder, thyroid, cervix, prostate, etc.)17 (11.6)–14 (15.4)–0.41*Pearson chi-squared test was applied with Yates correction when needed;**statistically significant difference between males and females.DiscussionThe frequency of deaths from malignancies does not necessarily correlate with the incidence or prevalence of malignancies seen in a locality. Therefore, the non-estimation of the case fatality for each malignancy is one of the limitations of this study. This could not be done due to the difficulty in the identification of the total number of cases from which death has resulted. However, the identification of the malignant diseases that cause the death of patients has an important role in future planning. Another limitation of this study is the fact that some patients may have died at home or in other referral hospitals. Nevertheless, since the majority of difficult and terminal cases were handled at Asir Central Hospital, figures on malignancy deaths at the hospital fairly reflect that of the Asir region as a whole.In a previous study from the same hospital, deaths over a four-year period at the hospital were reported.2 There were a total of 1479 deaths, and malignancy accounted for 18% of these. Although skin cancer has topped all malignancies in the Asir Region,3,4 Al-Baha,5 Jeddah,6 and has accounted for 4.2% of all newly diagnosed cases at the national level,7 it did not show up in the present study, perhaps due to the fact that skin cancer is not life threatening and is often less fatal.Hepatoma is the most common cancer in Saudi Arabia, according to the 1994 National Registry for Cancer,7 and the 4th most common malignancy in the Asir Region,3 5th in Medina,8 6th in Al-Baha,5 7th in Riyadh,9 12th in Dhahran,10 and 15th in Jeddah.6 This malignancy ranked first as a cause of death in males in the present study, a finding that reflects its position as a major killer in the Kingdom as a whole.Liver diseases have been shown in a previous report by one of the authors to represent 10% of all cases of mortality at the same institution.2 The national hepatitis vaccination program, which was started in 1989, as well as improvements in healthcare delivery, seem to have had a positive impact on the prevalence of hepatitis B.11,12 Nevertheless, more efforts are needed. Blood transfusion policies, especially regarding indication and screening, need urgent and major changes.Lymphoma among Saudis was shown to have a crude incidence rate of 4.2% and 2.2% for males and females, respectively, at the national level,6 while the incidence rate of leukemia was reported to be 3.6% and 2.2% among males and females, respectively. Therefore, these two groups of diseases represent a major health concern from the incidence and mortality point of view.Brain tumors ranked 9th in frequency in males both in the Asir Region3 and at the national level.7 However, the malignancy ranked 3rd as a cause of death in the present study in males, after hepatoma and lymphoma. Similarly, cancer of the pancreas was not among the 10 most common malignancies in the Asir Region, but it was the leading cause of death among females in the present study. These findings indicate that although both types of cancers are not generally common in the Kingdom, they constitute a major cause of mortality, especially in the face of possible limited experience in their management.It has been reported that the crude relative frequency of bladder cancer in the Southwestern region of Saudi Arabia is about double that of the rest of the country.13 It was also reported by Khan et al.3 to be the 4th most common malignancy in males. Cancer of the bladder ranked 5th for males and 33rd for females at the national level.7 However, in the present study, it ranked 12th as a cause of death. This finding indicates that although cancer of the bladder is relatively prevalent in the Asir Region, it has a low mortality rate compared to other neoplasms. The same conclusion applies to cancer of the thyroid, which ranked 5th in frequency in females in Asir, but was ranked 12th as a cause of death.Breast cancer is the most common malignancy among females, according to different studies in the Kingdom.6,7,10,12,13 This is in agreement with the rate in the Asir region,3 where it ranks second in frequency in females. With regards to mortality, breast cancer and lymphoma each accounted for 4.5% of deaths in females in the present study. This relatively high fatality of breast cancer necessitates more efforts towards early detection, such as education of females on self-examination of their breasts, and regular check-ups at the primary health care level.The malignant diseases that caused the deaths in Asir Central Hospital were identified in this study. This information should be of help in health planning, resource allocation and future research.ARTICLE REFERENCES:1. 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"Pattern of cancer in Saudi Arabs referred to King Faisal Specialist Hospital" . Cancer. 1986; 58:1172-8. Google Scholar Previous article Next article FiguresReferencesRelatedDetails Volume 21, Issue 3-4May/July 2001 Metrics History Received1 August 2000Published online1 May 2001Accepted10 July 2001 InformationCopyright © 2001, Annals of Saudi MedicineThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.PDF download