European Standard Population Research Articles

Breast cancer risk in a screening cohort of Asian and white British/Irish women from Manchester UK

BackgroundThe differences between breast cancer risk factors in white British/Irish and Asian women attending screening in the UK are not well documented.MethodsBetween 2009-15 ethnicity and traditional breast cancer risk factors were self-identified by a screening cohort from Greater Manchester, with follow up to 2016. Risk factors and incidence rates were compared using age-standardised statistics (European standard population).ResultsEight hundred and seventy-nine Asian women and 51,779 unaffected white British/Irish women aged 46-73 years were recruited. Asian women were at lower predicted breast cancer risk from hormonal and reproductive risk factors than white British/Irish women (mean 10 year risk 2.6% vs 3.1%, difference 0.4%, 95%CI 0.3-0.5%). White British/Irish women were more likely to have had a younger age at menarche, be overweight or obese, taller, used hormone replacement therapy and not to have had children.. However, despite being less overweight Asian women had gained more weight from age 20 years and were less likely to undertake moderate physical activity. Asian women also had a slightly higher mammographic density. Asian age-standardised incidence was 3.2 (95%CI 1.6-5.2, 18 cancers) per thousand women/year vs 4.5 (95%CI 4.2-4.8, 1076 cancers) for white British/Irish women.ConclusionsAsian women attending screening in Greater Manchester are likely to have a lower risk of breast cancer than white British/Irish women, but they undertake less physical activity and have more adult weight gain.

Abstract WP172: Stroke Incidence and Outcomes in Northeastern Greece: the Evros Stroke Registry

Introduction: Data are scarce on both stroke incidence rates and outcomes in Greece and in rural areas in particular. We performed a prospective population-based study evaluating the incidence of first-ever stroke in the Evros perfecture, a region of a total 147,947 residents located in North Eastern Greece. Methods: Adult patients with first ever stroke were registered during a 24-month period (2010-2012) and followed up for 12 months. To compare our stroke incidence with that observed in other studies, we standardized our incidence rate data according to the European Standard Population (ESP) of 2013 and applied criteria of data quality, as proposed by the Monitoring Trends and Determinants in Cardiovascular Disease (MONICA) project. Stroke diagnosis and classification was performed using WHO criteria on the basis of neuroimaging and/or autopsy data. Results: We prospectively documented 703 stroke cases (mean age: 75±12 years; 52.8% males; ischemic stroke (IS): 80.8%, intracerebral hemorrhage (ICH): 11.8%, subarachnoid hemorrhage (SAH): 4.4%, undefined: 3.0%) with a total follow-up time of 119,805 person-years. The unadjusted and ESP adjusted incidences of all strokes were 586.8 (95%CI: 543.4-630.2) and 534.3 (95%CI: 532.3-536.3) per 100,000 person-years, respectively. The unadjusted incidence rates for IS, ICH and SAH were 474.1 (95%CI: 435-513), 69.3 (95%CI: 54-84) and 25.8 (95%CI: 25.7-25.9) per 100,000 person-years, respectively. The corresponding ESP-adjusted incidence rates per 100,000 person-years were 425.9 (95%CI: 424-427), 63.3 (95%CI: 63-63.5) and 25.8 (95%CI: 25.7-25.9) for IS, ICH and SAH, respectively. The overall 30-day case fatality rate was 21.3% (95%: 18.3-24.4%) for all strokes, and was higher in hemorrhagic strokes than IS (40.4%, 95%CI: 31.3-49.4% vs 16.2%, 95%CI: 13.2%-19.2%). Conclusion: This is the largest to date population-based study in Greece documenting one of the highest stroke incidences in South-Eastern Europe.

Stroke Incidence and Outcomes in Northeastern Greece: The Evros Stroke Registry.

Data are scarce on both stroke incidence rates and outcomes in Greece and in rural areas in particular. We performed a prospective population-based study evaluating the incidence of first-ever stroke in the Evros prefecture, a region of a total 147 947 residents located in North Eastern Greece. Adult patients with first-ever stroke were registered during a 24-month period (2010-2012) and followed up for 12 months. To compare our stroke incidence with that observed in other studies, we standardized our incidence rate data according to the European Standard Population, World Health Organization, and Segi population. We also applied criteria of data quality proposed by the Monitoring Trends and Determinants in Cardiovascular Disease project. Stroke diagnosis and classification were performed using World Health Organization criteria on the basis of neuroimaging and autopsy data. We prospectively documented 703 stroke cases (mean age: 75±12 years; 52.8% men; ischemic stroke: 80.8%; intracerebral hemorrhage: 11.8%; subarachnoid hemorrhage: 4.4%; undefined: 3.0%) with a total follow-up time of 119 805 person-years. The unadjusted and European Standard Population-adjusted incidences of all strokes were 586.8 (95% confidence interval [CI], 543.4-630.2) and 534.1 (95% CI, 494.6-573.6) per 100 000 person-years, respectively. The unadjusted incidence rates for ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage were 474.1 (95% CI, 435-513), 69.3 (95% CI, 54-84), and 25.9 (95% CI, 17-35) per 100 000 person-years, respectively. The corresponding European Standard Population-adjusted incidence rates per 100 000 person-years were 425.9 (95% CI, 390.9-460.9), 63.3 (95% CI, 49.7-76.9), and 25.8 (95% CI, 16.7-34.9) for ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage, respectively. The overall 28-day case fatality rate was 21.3% (95% CI, 18.3%-24.4%) for all strokes and was higher in hemorrhagic strokes than ischemic stroke (40.4%, 95% CI, 31.3%-49.4% versus 16.2%, 95% CI, 13.2%-19.2%). This is the largest to date population-based study in Greece documenting one of the highest stroke incidences ever reported in South Europe, highlighting the need for efficient stroke prevention and treatment strategies in Northeastern Greece.

A nationwide epidemiological study of myasthenia gravis in Latvia.

Myasthenia gravis (MG) is an autoimmune disorder characterized by fatigable muscle weakness due to antibody-mediated impairment of neuromuscular transmission. The aim of this study was to investigate the incidence and prevalence of MG in Latvia, and to characterize this population by well-established clinical parameters such as age at onset, presence of associated antibodies and thymus pathology. All prevalent cases on 1 January 2015 and cases of patients newly presenting with MG symptoms from 1 January 2010 to 31 December 2014 were selected from the database of the Neuromuscular Disease Clinic of Pauls Stradins Clinical University Hospital and Children's Clinical University Hospital. Crude rates were calculated based on population data. These were directly age-standardized to the European and World Health Organization world standard populations. The analysis of clinical characteristics was carried out in a cohort of patients who had undergone a complete set of electrophysiological, serological and radiological investigations (n=153; 68%). During the study period 99 incident and 226 prevalent cases were identified. The total crude MG incidence was 9.7 per million person-years. The prevalence of MG on 1 January 2015 was 113.8 per million. 54.2% of patients tested positive for acetylcholine receptor antibodies, 7.8% for muscle specific kinase antibodies and 1.3% for lipoprotein related protein 4 antibodies. This is the first study of MG in Latvia and the second population-based study of MG in Eastern Europe. Our epidemiological results are similar to those in some other European and Northern American countries, and show high prevalence and increasing incidence of late-onset MG.

Trends in stroke mortality rates in Russia and the USA over a 15-year period

to comparatively analyze standardized mortality ratios (SMR) from stroke in the populations aged over 30 years in the Russian Federation and in the USA over a 15-year period. The analysis included nontraumatic subarachnoid hemorrhage (NTSH) (a group of ICD-10 codes I60), nontraumatic intracerebral hemorrhage (NTIH) (I61), cerebral infarction (CI) (I63), and stroke, not specified as hemorrhage or infarction (SNSHI) (I64). The new European standard (European Standard Population.2013) was used for standardization. The data of the Federal State Statistics Service of the Russian Federation, those of the World Health Organization Mortality Database (WHO MD) and Human Mortality Database (HMD) for the USA were applied. During the considered period, 30-49-year-old Russian men showed a reduction in SMRs from NTSH (I61) by 9.0% (from 18.9 to 17.2 per 100,000 population), from SNSHI (I64) by 10 times (from 12.5 to 1.3); SMRs from CI (I63) increased by 4.3% (from 6.9 to 7.2). In men aged 50 years and older, SMRs from NTIH and SNSHI decreased by 32.3% (from 143.2 to 97.0) and by 10 times (from 580.8 to 60.6), respectively; those from CI increased by 13.8% (from 229.8 to 261.4). In the USA, 30-49-year-old men displayed 26.1% and 2-fold decreases in SMRs from NTIH (from 2.5 per 100,000 population in 1999 to 1.7 in 2013) and CI (from 1.8 to 0.9), respectively; those from SNSHI remained unchanged (1.3). In men aged 50 years and older, SMRs from NTIH, CI, and SNSHI reduced by 39.7% (from 29.0 to 17.5), by 2 times (from 1.8 to 0.9), and by 2 times (143.0 to 72.5), respectively. 30-49-year-old Russian women exhibited a 22.2% reduction in SMRs from NTIH (from 9.0 to 7.0), a 4.3% increase in those from CI (from 2.7 to 2.8), and an 11-fold decrease in those from SNSHI (from 5.5 to 0.5). Women aged 50 years and older showed changes in SMRs from the codes in the same sequence from 105.6 to 60.5, from 172.8 to 189.6, and from 466.5 to 43.7, respectively. In the USA, 30-49-year-old women displayed reductions in SMRs from NTIH by 10.0% (from 1.5 to 0.9), from CI by 33.3% (from 0.3 to 0.2), and from SNSHI by 10% (from 1.0 to 0.9). Women aged 50 years and older exhibited changes in SMRs from the codes in the same sequence from 24.0 to 14.8), n those from CI (from 20.6 to 6.7) and from SNSHI (from 6.5 to 10.3). In Russia, the reduction in mortality rates from the above causes (which is most significant from that in NTSH may be associated with both medical and socioeconomic factors, including with the improved prevention and organization of medical care. The differences in SMRs between the two countries may be related to the principles in the organization and control of coding of the causes of death.

Inequalities in cancer deaths by age, gender and education

The economy of each state provides a significant amount of money into the health care system with the aim of knowing the health status of its population in the context of socioeconomic characteristics for effective resource allocation. In recent years, there is a growing number of cancer deaths in Slovakia. Therefore, the structure of cancer deaths according to its primary determinants, such as age, sex and education with the aim of effective implementation of prevention programs in Slovakia was examined. Main source of data on deaths from 1996 to 2014 was provided by National Health Information Centre in Slovakia. However, data were available only from 2011. Standardized mortality rate per 100,000 inhabitants was estimated by the method of direct standardization using European standard population. The R project for statistical computing was used for calculation of statistically significant differences among various groups of mortality. The results show that people with primary education die from cancer later than people with higher education. However, major differences related to both sex and age are present in people with university education. A different variety of cancers occur in childhood (neoplasm of brain), adolescents (neoplasm of bone), young adults (neoplasm of brain), or adults (lung cancer and breast cancer). Malignant neoplasm of brain was more prevalent at higher education levels, Malignant neoplasm of bladder and Malignant melanoma of skin were more prevalent at the university level of education. The results can be useful for economists to define the health priorities in each country, make the financial decisions in economics, and thus contribute to better health, economic growth, as well as effective spending of health expenditures.

Income Inequality in Non-communicable Diseases Mortality among the Regions of the Slovak Republic.

A great amount of non-communicable disease deaths poses a threat for all people and therefore represents the challenge for health policy makers, health providers and other health or social policy actors. The aim of this study is to analyse regional differences in non-communicable disease mortality in the Slovak Republic, and to quantify the relationship between mortality and economic indicators of the Slovak regions. Standardised mortality rates adjusted for age, sex, region, and period were calculated applying direct standardisation methods with the European standard population covering the time span from 2005 to 2013. The impact of income indicators on standardised mortality rates was calculated using the panel regression models. The Bratislava region reaches the lowest values of standardised mortality rate for non-communicable diseases for both sexes. On the other side, the Nitra region has the highest standardised mortality rate for non-communicable diseases. Income quintile ratio has the highest effect on mortality, however, the expected positive impact is not confirmed. Gini coefficient at the 0.001 significance level and social benefits at the 0.01 significance level look like the most influencing variables on the standardised mortality rate. By addition of one percentage point of Gini coefficient, mortality rate increases by 148.19 units. When a share of population receiving social benefits increases by one percentage point, the standardised mortality rate will increase by 22.36 units. Non-communicable disease mortality together with income inequalities among the regions of the Slovak Republic highlight the importance of economic impact on population health.

Time Trend, Age and Sex Distribution of Deceased from Diabetes Mellitus at the Regional Level in the Slovak Republic.

To describe the time trends, age and sex distribution of death from diabetes mellitus (E10-E14) as a significant part of endocrine, nutritional and metabolic diseases (E00-E90), during 1996-2014 in the Slovak regions, and to estimate the influence of social characteristics on mortality. Secondary data on deaths during 1996-2014 were gathered from the National Health Information Center in the Slovak Republic. The total crude death rate per 100,000 of the standard Slovak population and age-standardized death rate per 100,000 of the standard European population were calculated by direct standardization. Multilevel logistic regression analysis was performed. Deaths from diabetes mellitus account for 91.6% of deaths registered in the endocrine, nutritional and metabolic diseases Chapter. The age-standardized death rate per 100,000 of inhabitants decreased from 19.2 in 1996 to 15.3 in 2014 in the Slovak Republic, although a massive increase of up to 32.5 was reported in 1999. The highest age-standardized death rates per 100,000 inhabitants were typical for the Košice, Nitra and Trenčín regions. On the other hand, the lowest counts were recorded in the Bratislava region. Mortality from diabetes mellitus starts to be evident in the 45-49 year age-group in both sexes. The median age of death for women is lower in the 75-79 year age-group in comparison to men although the total crude death rate for men in lower age groups is higher. After age 80 the situation is reversed. The odds of dying due to endocrine, nutritional and metabolic diseases decreases by 0.4% each year. The odds of dying are lower by 17% and 12.3%, respectively, in the Žilina and Prešov regions compared to Bratislava region. Women have a higher probability of dying by 38% in contrast to men, and married couples by 16.7% than singles. Age is proved to be an insignificant factor. In spite of the declining trend of mortality from diabetes mellitus, it is necessary to reduce the risk of its incidence by healthier food consumption and physical activity.

Trends in prostate cancer incidence between 1996 and 2013 in two Swiss regions by age, grade, and T-stage.

To investigate differences in prostate cancer incidence between two distinct Swiss regions from 1996 to 2013 stratified by age group, grade, and T-stage. The dataset included 17,495 men living in Zurich and 3,505 men living in Ticino, diagnosed with prostate cancer between 1996 and 2013. We computed age-standardized incidence rates per 100,000 person-years using the European Standard Population. Trends were assessed using JoinPoint regression analysis Software. Age-standardized incidence rates were generally higher in Zurich compared to Ticino but the difference decreased over time. Incidence rates increased significantly up to 2002 in Zurich and 2007 in Ticino and then decreased. A statistically significant increase was observed for men aged < 65 years, for grade 3 tumors, and for T-stage 2 and 3 tumors. The largest decrease was seen for grade 1 tumors. Furthermore, the incidence of tumors of unknown grade or T-stage decreased significantly in both regions. The trends in prostate cancer incidence rates were similar in both regions, although on a higher level in Zurich compared to Ticino. However, the difference decreased over time. The distribution of T-stage and grade did not explain the difference in incidence rates. Different use of opportunistic screening may play a role.

Temporal trends and patterns in heart failure incidence: a population-based study of 4 million individuals

SummaryBackgroundLarge-scale and contemporary population-based studies of heart failure incidence are needed to inform resource planning and research prioritisation but current evidence is scarce. We aimed to assess temporal trends in incidence and prevalence of heart failure in a large general population cohort from the UK, between 2002 and 2014.MethodsFor this population-based study, we used linked primary and secondary electronic health records of 4 million individuals from the Clinical Practice Research Datalink (CPRD), a cohort that is representative of the UK population in terms of age and sex. Eligible patients were aged 16 years and older, had contributed data between Jan 1, 2002, and Dec 31, 2014, had an acceptable record according to CPRD quality control, were approved for CPRD and Hospital Episodes Statistics linkage, and were registered with their general practice for at least 12 months. For patients with incident heart failure, we extracted the most recent measurement of baseline characteristics (within 2 years of diagnosis) from electronic health records, as well as information about comorbidities, socioeconomic status, ethnicity, and region. We calculated standardised rates by applying direct age and sex standardisation to the 2013 European Standard Population, and we inferred crude rates by applying year-specific, age-specific, and sex-specific incidence to UK census mid-year population estimates. We assumed no heart failure for patients aged 15 years or younger and report total incidence and prevalence for all ages (>0 years).FindingsFrom 2002 to 2014, heart failure incidence (standardised by age and sex) decreased, similarly for men and women, by 7% (from 358 to 332 per 100 000 person-years; adjusted incidence ratio 0·93, 95% CI 0·91–0·94). However, the estimated absolute number of individuals with newly diagnosed heart failure in the UK increased by 12% (from 170 727 in 2002 to 190 798 in 2014), largely due to an increase in population size and age. The estimated absolute number of prevalent heart failure cases in the UK increased even more, by 23% (from 750 127 to 920 616). Over the study period, patient age and multi-morbidity at first presentation of heart failure increased (mean age 76·5 years [SD 12·0] to 77·0 years [12·9], adjusted difference 0·79 years, 95% CI 0·37–1·20; mean number of comorbidities 3·4 [SD 1·9] vs 5·4 [2·5]; adjusted difference 2·0, 95% CI 1·9–2·1). Socioeconomically deprived individuals were more likely to develop heart failure than were affluent individuals (incidence rate ratio 1·61, 95% CI 1·58–1·64), and did so earlier in life than those from the most affluent group (adjusted difference −3·51 years, 95% CI −3·77 to −3·25). From 2002 to 2014, the socioeconomic gradient in age at first presentation with heart failure widened. Socioeconomically deprived individuals also had more comorbidities, despite their younger age.InterpretationDespite a moderate decline in standardised incidence of heart failure, the burden of heart failure in the UK is increasing, and is now similar to the four most common causes of cancer combined. The observed socioeconomic disparities in disease incidence and age at onset within the same nation point to a potentially preventable nature of heart failure that still needs to be tackled.FundingBritish Heart Foundation and National Institute for Health Research.

Trends in incidence of lung cancer in Croatia from 2001 to 2013: gender and regional differences.

AimTo provide an overview of the lung cancer incidence trends in the City of Zagreb (Zagreb), Split-Dalmatia County (SDC), and Croatia in the period from 2001 to 2013.MethodIncidence data were obtained from the Croatian National Cancer Registry. For calculating incidence rates per 100 000 population, we used population estimates for the period 2001-2013 from the Croatian Bureau of Statistics. Age-standardized rates of lung cancer incidence were calculated by the direct standardization method using the European Standard Population. To describe incidence trends, we used joinpoint regression analysis.ResultsJoinpoint analysis showed a statistically significant decrease in lung cancer incidence in men in all regions, with an annual percentage change (APC) of -2.2% for Croatia, 1.9% for Zagreb, and -2.0% for SDC. In women, joinpoint analysis showed a statistically significant increase in the incidence for Croatia, with APC of 1.4%, a statistically significant increase of 1.0% for Zagreb, and no significant change in trend for SDC. In both genders, joinpoint analysis showed a significant decrease in age-standardized incidence rates of lung cancer, with APC of -1.3% for Croatia, -1.1% for Zagreb, and -1.6% for SDC.ConclusionThere was an increase in female lung cancer incidence rate and a decrease in male lung cancer incidence rate in Croatia in 2001-20013 period, with similar patterns observed in all the investigated regions. These results highlight the importance of smoking prevention and cessation policies, especially among women and young people.

Incidence trends of type 1 diabetes before and after the reunification in children up to 14 years of age in Saxony, Eastern Germany.

AimsThe aim of this study was to analyze the incidence rates of type 1 diabetes in Saxony before and after the German reunification.MethodsThe study examined two registries: one until 1990 and one since 1999. Only patients under 15 years of age with type 1 diabetes and living in Saxony were included in the study. Standardized incidence rates were described based on direct age standardization procedures using the Standard European Population for each calendar year between the observation periods 1982–1989 and 1999–2014. Age was grouped into three classes: 0–4, 5–9 and 10–14 years of age. Incidence data were presented as age-standardized incidence rates per 100,000 person-years (PY) with 95% confidence intervals [CI]. Joinpoint regression was used for trend analyses and Poisson regression was used to adjust for the effects of age and sex on the incidence.ResultsA total number of 2,092 incident cases of type 1 diabetes (1,109 males; 983 females) were included. The age-standardized incidence rates of type 1 diabetes per 100,000 PY was 7.9 [95%CI 6.8; 8.9] in the period from 1982–1989 and 20.1 [95%CI 14.0; 26.1] in the period from 1999–2014. The yearly increase in incidence over the entire time period (1982–2014) was 4.3% according to the average annual percent change (AAPC) method, and estimated to be 4.4% [95% CI 4.0; 4.8%] using a Poisson regression model adjusting for sex and age group.ConclusionIn this study, a significantly increasing incidence of type 1 diabetes was observed after reunification. In future studies it would be interesting to follow up on the question of which environmental and lifestyle factors could be causing the increasing type 1 diabetes incidence.

An evaluation of cause-of-death trends from recent decades based on registered deaths in Turkey

ObjectivesAlthough cause-of-death analyses are very important to define public health policy priorities and to evaluate health programs, there is very limited knowledge about mortality profiles and trends in Turkey. The aim of this study was to measure the trends in mortality within three broad cause-of-death groups and their distribution by age groups and gender and to describe the changes of leading causes of death between 1980 and 2013 in Turkey. Study designDescriptive study. MethodsIn the study, data on the number of deaths by year, gender, age and cause was obtained from the Turkish Statistical Institute. The causes of death were classified as group I: communicable, maternal, perinatal, and nutritional conditions; group II: non-communicable diseases (NCDs); and group III: injuries. Unknown or ill-defined causes of death were distributed within group I and group II. The percentage distribution of the cause-of-death groups by gender and age groups between 1980 and 2013 was identified. Age-standardized mortality rates (ASMRs) per 100,000 of broad causes-of-death groups were calculated using European Standard Population 1976 between 1980 and 2008. Changes in mortality rates per hundred were calculated using the formula ([the rate of last year of the period−the rate of the first year of the period]/the rate of the first year of the period). Gender and age-specific data were analyzed using the Joinpoint software to examine trends and significant changes in trends of mortality rates. ResultsCrude death rates for group I, group II, and group III were 157.3, 147.2, and 21.4 per 100,000 in 1980 and 35.3, 377.5, and 15.8 in 2008 for males; 161.8, 120.2, and 5.8 in 1980 and 38.6, 318.4, and 6.4 in 2008 for females, respectively. ASMRs for group I, group II, and group III were 146.3, 394.3, and 29.3 per 100,000 in 1980 and 49.7, 723.6, and 18.8 in 2008 for males; 138.0, 291.5, and 7.6 per 100,000 in 1980 and 47.7, 478.8, and 7.2 in 2008 for females, respectively. The mortality rates of group I for almost all age groups particularly below 5 years of age decreased significantly. ConclusionThis study indicates that Turkey is at an advanced stage in the epidemiological transition, with the majority of the causes of death from NCDs. Considering the regional differences, it is necessary to carry out studies on the specific details of epidemiological transition and the social determinants of deaths in Turkey.

The need for a rapid and comprehensive adoption of the revised European standard population in cancer incidence comparisons.

As cancer incidence varies according to age, it is important to rule out differences in age structures in any comparison. A common way of adjusting for these differences is using direct age standardization, which applies age-specific weights from a standard population. Eurostat has recently introduced a revised European standard population (RESP). The effect of using the new standard, in comparison with that introduced in 1976 [European standard population (ESP)], is evaluated. Cancer incidence data for prostate and testis cancer for Denmark, Finland, Sweden, Norway, and Iceland from the NORDCAN web site, and for Ireland and Italy-Genoa from Cancer Incidence in five Continents-X, were analyzed. Incidence rates were directly age standardized using ESP and RESP. The RESP conferred greater weight to adults and the elderly than the ESP. For prostate cancer, age-standardized rates computed with RESP are consistently higher by between 50 and 60% than those computed with ESP. However, the use of RESP, instead of ESP, has little impact on the pattern of time trends, the relative ranking of countries, the values of relative risks, or the percentage differences between age-standardized rates. For testis cancer, RESP and ESP provide very similar results because this cancer is more common in young men. Both ESP and RESP are in circulation. It is, therefore, important that European cancer registries reach consensus on a single standard to use to avoid erroneous comparisons of data computed with different standards. Given that Eurostat recently introduced RESP and is using this standard for data collected from the European Union Member States, it would make sense to rally behind RESP.

Comparing trends in mortality from cardiovascular disease and cancer in the United Kingdom, 1983\u20132013: joinpoint regression analysis

BackgroundWe aimed to study the time trends underlying a change from cardiovascular disease (CVD) to cancer as the most common cause of age-standardized mortality in the UK between 1983 and 2013.MethodsA retrospective trend analysis of the World Health Organization mortality database for mortality from all cancers, all CVDs, and their three most common types, by sex and age. Age-standardized mortality rates were adjusted to the 2013 European Standard Population and analyzed using joinpoint regression analysis for annual percent changes.ResultsThe difference in mortality rate between total CVD and cancer narrowed over the study period as age-standardized mortality from CVD decreased more steeply than cancer in both sexes. We observed higher overall rates for both diseases in men compared to women, with high mortality rates from ischemic heart disease and lung cancer in men. Joinpoint regression analysis indicated that trends of decreasing rates of CVD have increased over time while decreasing trends in cancer mortality rates have slowed down since the 1990s. The lowest improvements in mortality rates were for cancer in those over 75 years of age and lung cancer in women.ConclusionsIn 2011, the age-standardized mortality rate for cancer exceeded that of CVD in both sexes in the UK. These changing trends in mortality may support evidence for changes in policy and resource allocation in the UK.

Incidence, Treatment and Mortality in Patients with Abdominal Aortic Aneurysms.

Aim of this study was to analyze hospital incidence, type of treatment, and hospital mortality rates of patients with abdominal aortic aneurysm (AAA) in Germany from 2005 to 2014. Microdata of the diagnosis-related group (DRG) statistics compiled by the German Federal Statistical Office for the years 2005-2014 were analyzed. Patients who were hospitalized for a ruptured AAA (rAAA, ICD-10 code I71.3, treated either surgically or conservatively) or received surgical treatment for an unruptured AAA (nrAAA, ICD-10-Code I71.4, treated either with open surgery or an endovascular procedure) were included in the analysis. The "European Standard Population 2013" was used for direct standardization of the hospital incidences. In-hospital mortality was calculated with standardization for age and risk. The standardized overall hospital incidence of AAA was 27.9 and 3.3 cases per 100 000 people for men and women, respectively; over the period of the study, the incidence of rAAA fell by 30% in both sexes and that of nrAAA rose by 16% in men and 42% in women. The percentage of patients receiving endovascular treatment rose from 29% to 75% in patients with nrAAA and from 8% to 36% in patients with rAAA. The age- and risk-standardized in-hospital mortality of nrAAA was 3.3% in men and 5.3% in women. The in-hospital mortality of surgically treated rAAA was 39% in men and 48% in women. The hospital incidence of AAA rose from 2005 to 2014, while that of rAAA fell. Endovascular treatment became more common for nrAAA as well as rAAA, and in-hospital mortality fell for both.

Disability-adjusted life years lost due to ischemic heart disease in mainland Portugal, 2013

Introduction and ObjectivesEstimates of the burden of ischemic heart disease (IHD), including geographic differences, should support health policy decisions. We set out to estimate the burden of IHD in mainland Portugal in 2013 by calculating disability-adjusted life years (DALYs) and to compare this burden between five regions. MethodsYears of life lost (YLLs) were calculated by multiplying the number of IHD deaths in 2013 (Statistics Portugal) by the life expectancy at the age at which death occurred. Years lived with disability (YLDs) were computed as the number of cases of acute coronary syndrome, stable angina and ischemic heart failure multiplied by an average disability weight. Crude and age-standardized DALYs (direct method, Standard European Population) were calculated for mainland Portugal and for the Northern, Central, Lisbon, Alentejo and Algarve regions. ResultsIn 2013, 95413 DALYs were lost in mainland Portugal due to IHD. YLLs accounted for 88.3% of the disease burden. Age-standardized DALY rates per 1000 population were higher in men than in women, across the entire country (8.9 in men; 3.4 in women) and within each region, ranging from 7.3 in the Northern and Central regions to 11.8 in the Algarve in men, and from 2.6 in the Northern region to 4.6 in Lisbon in women. ConclusionsNearly 100000 DALYs were lost to IHD in Portugal, mostly through early mortality. This study enables accurate comparisons with other countries and between regions; however, it highlights the need for population-based studies to obtain specific data on morbidity.

Incidence trends and clinical-pathological characteristics of invasive cutaneous melanoma from 1980 to 2010 in the Canton of Zurich, Switzerland.

The aims of this paper are to describe the incidence trends of invasive cutaneous melanoma in the Canton of Zurich and to evaluate clinical and pathological factors such as cancer subtype, localization, age and Breslow thickness. A retrospective analysis was carried out with data from the population-based Cancer Registry of Zurich and Zug located in Zurich. A total of 8469 cases in 8034 different patients of invasive cutaneous melanoma were registered for the period 1980-2010 in the Canton of Zurich. Incidence trends were age standardized to the European standard population. Joinpoint regression was used to compute changes in incidence and mortality rates, measured as the annual percent change (APC). The most common subtypes of cutaneous melanoma were superficial spreading melanoma (SSM, 41.1%), followed by nodular melanoma (16.5%), lentigo maligna melanoma (13.5%), acral-lentiginous melanoma (5.0%) and other types of melanoma (2.8%); 21.1% were melanoma not otherwise specified. The trunk was the most frequent location (30.8%), followed by the lower limb and hip (26.4%) and the upper limb and shoulder (22.8%). Statistically significantly increasing incidence trends were observed for both men (APC=3.0%) and women (APC=2.1%). Incidences of SSM and melanoma not otherwise specified were the histological subtypes for which a significant increase in incidence was observed (APC for the period 1980-2010=3.2% for both). In terms of Breslow thickness, thin melanomas (0.01-1.00 mm) showed an increasing incidence. The incidence of melanoma increased in both men and women between 1980 and 2010. In terms of the different subtypes and Breslow thickness, increasing incidences of the SSM and of thin melanomas (0.01-1.00 mm) were observed. These observations are in agreement with other studies from Southern and Western Switzerland as well as other European countries and the USA.

Trends in the incidence of lower limb amputation after implementation of a Multidisciplinary Diabetic Foot Unit

Backgrounds and objectiveIncidence of lower extremity amputations (LEA) in the population with and without diabetes mellitus (DM) was assessed after implementation of a Multidisciplinary Diabetic Foot Unit (MDFU) during 2008. Material and methodsNon-traumatic LEA were analyzed, and those performed before (2001–2007) and after (2008–2014) introduction of the MDFU were compared. LEA were grouped by age and sex. Their incidence was expressed as a rate per 100,000 population per year, adjusted to the standard European population. ResultsA total of 664 LEA were performed during the 2001–2014 period, 486 (73%) of them in patients with DM. Total LEA incidence was 11.2/105 population in DM versus 3.9/105 in the population without DM. Incidence of major LEA in patients with DM significantly decreased from 6.1/105 population in the 2001–2007 period to 4.5/105 in the 2008–2014 period (p=0.03). Joinpoint regression analysis also showed a reduction in the trend of incidence of major LEA in patients with DM, with an annual percentage change of −3.3% [95% CI, −6.2–0.3] (p=0.025). No significant differences were found for all other incidences and trends in the diabetic and non-diabetic populations. ConclusionsImplementation of a MDFU has been shown to be associated with a significant reduction in major amputation rate in the diabetic population, although the results are not optimal yet. Both results and work at the MDFU should be improved.

Tendencia de la incidencia de amputaciones de miembro inferior tras la implementación de una Unidad Multidisciplinar de Pie Diabético

Backgrounds and objectiveIncidence of lower extremity amputations (LEA) in the population with and without diabetes mellitus (DM) was assessed after implementation of a Multidisciplinary Diabetic Foot Unit (MDFU) during 2008. Material and methodsNon-traumatic LEA were analyzed, and those performed before (2001-2007) and after (2008-2014) introduction of the MDFU were compared. LEA were grouped by age and sex. Their incidence was expressed as a rate per 100,000 population per year, adjusted to the standard European population. ResultsA total of 664 LEA were performed during the 2001-2014 period, 486 (73%) of them in patients with DM. Total LEA incidence was 11.2/105 population in DM versus 3.9/105 in the population without DM. Incidence of major LEA in patients with DM significantly decreased from 6.1/105 population in the 2001-2007 period to 4.5/105 in the 2008-2014 period (p=.03). Joinpoint regression analysis also showed a reduction in the trend of incidence of major LEA in patients with DM, with an annual percentage change of -3.3% [95% CI, -6.2-0.3] (p=.025). No significant differences were found for all other incidences and trends in the diabetic and non-diabetic populations. ConclusionsImplementation of a MDFU has been shown to be associated with a significant reduction in major amputation rate in the diabetic population, although the results are not optimal yet. Both results and work at the MDFU should be improved.