Cancer Standardized Mortality Research Articles

Socio-economic inequalities in lung cancer mortality in Spain: a nation-wide study using area-based deprivation

BackgroundLung cancer is the main cause of cancer mortality worldwide and in Spain. Several previous studies have documented socio-economic inequalities in lung cancer mortality but these have focused on specific provinces or cities. The goal of this study was to describe lung cancer mortality in Spain by sex as a function of socio-economic deprivation.MethodsWe analysed all registered deaths from lung cancer during the period 2011–2017 in Spain. Mortality data was obtained from the National Institute of Statistics, and socio-economic level was measured with the small-area deprivation index developed by the Spanish Society of Epidemiology, with the census tract of residence at the time of death as the unit of analysis. We computed crude and age-standardized rates per 100,000 inhabitants by sex, deprivation quintile, and type of municipality (rural, semi-rural, urban) considering the 2013 European standard population (ASR-E). We further calculated ASR-E ratios between the most deprived (Q5) and the least deprived (Q1) areas and mapped census tract smoothed standardized lung cancer mortality ratios by sex.ResultsWe observed 148,425 lung cancer deaths (80.7% in men), with 73.5 deaths per 100,000 men and 17.1 deaths per 100,000 women. Deaths from lung cancer in men were five times more frequent than in women (ASR-E ratio = 5.3). Women residing in the least deprived areas had higher mortality from lung cancer (ASR-E = 22.2), compared to women residing in the most deprived areas (ASR-E = 13.2), with a clear gradient among the quintiles of deprivation. For men, this pattern was reversed, with the highest mortality occurring in areas of lower socio-economic level (ASR-E = 99.0 in Q5 vs. ASR-E = 86.6 in Q1). These socio-economic inequalities remained fairly stable over time and across urban and rural areas.ConclusionsSocio-economic status is strongly related to lung cancer mortality, showing opposite patterns in men and women, such that mortality is highest in women residing in the least deprived areas and men residing in the most deprived areas. Systematic surveillance of lung cancer mortality by socio-economic status may facilitate the assessment of public health interventions aimed at mitigating cancer inequalities in Spain.

Projection of morbidity and mortality due to breast cancer between 2020 and 2050 across 42 low- and middle-income countries

ObjectiveAim of the study is to predict trends in morbidity and mortality due to breast cancer in 42 LMICs between 2020 and 2050. Designand Setting: National level cross-sectional breast cancer related data between 1990 and 2019 were used. Recurrent Neural Network, Long-Short-Term Memory (RNN-LSTM) model was employed to forecast the trend in breast cancer burden. Main outcomes and measuresAge standardized breast cancer incidence, mortality, and disability adjusted life years (DALYs) rates. ResultsBy 2050, the age standardized breast cancer incidence rate is expected to increase in 38 LMICs with highest incidence rate in Namibia; 127.0 (78.0–176.0) followed by Nigeria 71.1 (53.9–88.3) and Papua New Guinea 70.6 (88.7–74.6). Similarly, the age standardized breast cancer mortality and DALYs rates in 2050 are expected to increase in 33 and 35 LMICs respectively. The highest mortality and DALYs rates in 2050 are expected to be 64.7 (42.6–86.7) in Namibia and 1543.6 (1463.1–1624.1) in Pakistan. The estimated annual percentage change (EAPC) is expected to increase uniformly in all the countries during the same period. Due to considerable variation in exposure risk, such as high plasma glucose level, high body mass index (BMI) and socio-demographic index (SDI), high regional disparity in burden of breast cancer is expected among the countries. Conclusionand Relevance: Breast cancer burden is expected to increase in most of the LMICs with high regional disparity by 2050. Our study's finding focuses on LMICs with high breast cancer burden that require tailored strategies and effective action plans to ensure prevention from catastrophic consequences in the future. Minimizing the exposure to behavioral and metabolic risk factors such as high plasma glucose, high BMI, along with tackling the issue of low fertility rate would be important in managing breast cancer burden in LMICs.

Cancer Incidence in Korean Healthcare Workers in Hospitals

Healthcare workers in hospitals (HHCWs), a notably increasing workforce, face various occupational hazards. A high incidence of cancer among HHCWs has been observed; however, the cancer incidence status among HHCWs in South Korea is yet to be studied. This study aimed to assess cancer incidence among HHCWs in South Korea. We constructed a retrospective cohort of HHCWs using National Health Insurance claims data, including cancer incidence status and vital status, from 2007 to 2015. Those who had worked in hospitals for at least three years were defined as HHCWs. Standardized incidence ratios (SIRs) for all cancer types and standardized mortality ratios were calculated. A total of 107,646 HHCWs were followed up, and the total follow-up duration was 905,503 person-years. Compared to the total workers, female HHCWs showed significantly higher SIR for all cancers (observed cases = 1480; SIR = 1.25; 95% confidence interval [CI] = 1.06-1.47). The incidence of breast cancer among female HHCWs was significantly higher compared to that among total workers (observed cases = 376; SIR = 1.21; 95% CI = 1.09-1.36). Our findings indicate that female HHCWs have an elevated probability of developing cancer, which suggests that occupational risk factors such as night-shift work, anti-neoplastic medications, stressful jobs, and ionizing radiation should be assessed. Further investigation and occupational environment improvement activities are required.

Breast Cancer Screening in Latin America: The Challenge to Move from Opportunistic to Organized-Systematic Screening

Background: Breast cancer is the leading cause of death from cancer among women in Latin America. Most Latin American countries started national mammogram screening programs a decade ago. The implementation level and effects of screening programs in Latin America have not been evaluated. Aim: To evaluate the association between screening programs implementation and breast cancer mortality in selected North American and European countries compared to a group of Latin American countries with national screening programs. Methods: The study applied an ecological design with secondary data from official national and international sources. Join point regression analysis was conducted to describe the trends in mortality rates in a group of five Latin American countries (Brazil, Chile, Colombia, Costa Rica and Mexico) with five Non-Latin American countries (Canada, Spain, Sweden, United Kingdom and the United States of America). The association between screening and mortality rates was explored using correlation and linear regression. National cancer plans were assessed to describe screening strategies among selected countries. Results: A significant reduction in standardized breast cancer mortality rates was observed in all Non-Latin American countries with an Average Annual Percent Change (AAPC) of -2.00 (p<.05, 95%CI [-3.33, -0.70]) for the period 2010-2020. In contrast, Latin American countries reported a significant increase in the AAPC of +1.38 (p<.05, 95%CI [0.86,1.76]) in breast cancer mortality rates for the period 2010-2020. For Latin American countries, with screening rates below 50%, there was no correlation between screening and mortality rates for the period 1985-2020 (r = -0.17, p = .78). For non-Latin American countries, with screening rates over 70%, the linear regression model explained significantly 55% of the variance in mortality rates (R2aj =.55, F (5,14) = 5.69, p = .005), with a negative and significant effect of mammogram screening on mortality rates (β = -0.14, p = .01). The National Plans analysis revealed an opportunistic screening model for Latin American countries and an organized-systematic model in Non-Latin American countries. Conclusion: There is an association between the level of implementation of screening programs and mortality rates from breast cancer. Latin American countries should transform their opportunistic strategy into an organized-systematic model.

Cancer mortality in the State of Mato Grosso from 2000 to 2015: temporal trend and regional differences.

To analyze the trend of standardized cancer mortality rate in the state of Mato Grosso according to health regions, from 2000 to 2015. Ecological time series study with data on deaths by cancer from the Mortality Information System. The rates were standardized using direct method and calculated by year and health regions. The annual percentage changes (APC) and respective confidence interval (95%CI) were obtained through simple linear regression. Thematic maps were built to show the spatial distribution of rates. There were 28,525 deaths by cancer registered in Mato Grosso, with the main types being lung, prostate, stomach, breast and liver cancer. The highest mortality rates were found in regions Médio Norte, Baixada Cuiabana and Sul Mato-Grossense. From 2000 to 2015, an upward trend was seen in the mortality rate by cancer in Mato Grosso (APC=0.81%; 95%CI 0.38-1.26), and in four health regions, Garças Araguaia (APC=2.27%; 95%CI 1.46-3.08), Sul Mato-Grossense (APC=1.12%; 95%CI 0.28-1.97), Teles Pires (APC=1.93%; 95%CI 0,11-3,74) and Vale dos Arinos (APC=2.61%; 95%CI 1.10-4.70), while the other regions remained stable. In the state of Mato Grosso and in the four health regions, cancer mortality rate showed a growing trend. The results point to the need to consider regional differences when thinking about actions for cancer prevention, control and assistance.

Lung cancer incidence and mortality trends
 in the Republic of Belarus
 (1990-2019)

favorable malignant diseases globally. In the Republic of Belarus, it ranks third (8.2%) in the cancer incidence structure and
 first (21.5%) in the cancer mortality structure.
 The object of the study were the lung cancer incidence and
 mortality trends in the Republic of Kazakhstan in 1990-2019.
 Methods: The present study included all patients - residents of Belarus, registered in the national cancer registry from
 1990 to 2019 with a diagnosis of lung cancer (ICD-10 code:
 C33-C34). Demographic variables included gender, age, and
 area of residence (urban or rural). The number of PD cases is
 presented as absolute values and rough intensity indicators
 per 100,000 population. Standardized morbidity and mortality
 rates are calculated using the world standard (World) and are
 indicated per 100,000 population.
 Results: In the study period, the standardized incidence
 rate decreased from 27.5 to 25.6 per 100 000 population
 (– 7.1%, p<0.01). In males, it decreased from 62.1 to 54.6 per 100
 000 males (– 12.1%, p<0.001); in females, it increased from 5.3
 to 6.4 per 100 000 females (+20.7%, p<0.05).
 The standardized lung cancer mortality rate has decreased
 over the study period from 23.0 to 18.3 per 100 000 population
 (– 20.4%, p<0.001). In males, it went down from 53.6 to 40.7 (–
 24.1%, p<0.001), and in women it changed slightly from 3.6 to
 3.7 (+2.8%, p>0.05) per 100 000 of the relevant sex. The average annual increase in standardized mortality decreased eight
 times faster than the growth in standardized incidence.
 Conclusion: In the Republic of Belarus, lung cancer incidence is increasing in males and decreasing in females. At that,
 lung cancer mortality is decreasing. Quality specialized cancer
 care creates conditions for quicker negative growth of lung cancer standardized mortality vs. incidence

Lung cancer incidence and mortality trends in the Republic of Belarus (1990–2019)

Аннотация:
 
 Relevance: Lung cancer is one of the most frequent and unfavorable malignant diseases globally. The Republic of Belarus ranks third (8.2%) in cancer incidence and first (21.5%) in cancer mortality.
 The object of the study was the lung cancer incidence and mortality trends in the Republic of Kazakhstan in 1990-2019.
 Results: In the study period, the standardized incidence rate decreased from 27.5 to 25.6 per 100 000 population (- 7.1%, p<0.01). In males, it decreased from 62.1 to 54.6 per 100 000 males (- 12.1%, p<0.001); in females, it increased from 5.3 to 6.4 per 100 000 females (+20.7%, p<0.05). The standardized lung cancer mortality rate has decreased over the study period from 23.0 to 18.3 per 100 000 population (- 20.4%, p<0.001). In males, it went down from 53.6 to 40.7 (- 24.1%, p<0.001), and in women it changed slightly from 3.6 to 3.7 (+ 2.8%, p>0.05) per 100 000 of the relevant sex. The average annual increase in standardized mortality decreased eight times
 faster than the growth in standardized incidence.
 Conclusion: In the Republic of Belarus, lung cancer incidence is increasing in males and decreasing in females. At that, lung cancer mortality is decreasing. Quality specialized cancer care creates conditions for quicker negative growth of lung cancer standardized mortality vs. incidence

PAPILLOMAVIRAL CARCINOGENESIS. MAJOR ACHIEVEMENTS AND CERTAIN CHALLENGES PART 2. HPV-ASSOCIATED CANCERS IN RUSSIA. PREVENTIVE HPV VACCINES

Cervical cancer (CC) incidence rate made up about 5 % in overall women cancer incidence in Russia in 2015. CC morbidity rose by 24.47 %during 2005–2015. Despite the fact that aggregated standardized cancer mortality rates for both men and women during 2005–2015 declined, women CC mortality increased by 8.3 %. CC is the leading cancer mortality cause in women aged 30–39 years. Moreover growth of oraland pharynx cancer incidence rates in both genders as well as penile cancer in men all indicate to an unfavorable trend. The present Reviewpart contains data on HPV-associated cancers in Russia, vertical HPV transition as well as preventive HPV vaccines.

Spatial autocorrelation of breast cancer mortality in the Metropolitan Region, Chile: an ecological study

Breast cancer is the most common malignancy in women worldwide and Chile, being the leading cause of female cancer death. A wide variation in mortality has been reported, with geographic clusters of higher risk. To spatially analyze mortality from breast cancer in women in the Metropolitan Region in 2015. Ecological study of location. We used death records in 2015 (C50 according to ICD10) and population projections of the Statistics Institute to estimate mortality rates. We calculated crude breast cancer mortality rates and standardized mortality ratios and performed a spatial epidemiological analysis of breast cancer mortality in women, estimating the global and local Moran I index to assess spatial autocorrelation. We present the results in maps according to the 2016 pre-census cartography. There were 622 deaths from breast cancer in the Metropolitan Region in 2015. The mean age was 66 years (SD: 15.5). 92.4% of deaths were registered in urban or central areas. However, the highest mortality rates were observed in peripherical districts. No global spatial autocorrelation was observed in the region (Morans I 0.007 p = 0.134). However, at the local level, four districts differ significantly from their neighbors. The risk of dying from breast cancer in the Metropolitan Region of Chile is concentrated in women from peripherical communes. Four districts in the region present different risks from their neighboring districts. It is necessary to investigate local realities to prevent deaths from this pathology.

Oncologist Burnout Syndrome in Eastern Europe: Results of the Multinational Survey.

Burnout is defined as a three-dimensional syndrome-emotional exhaustion (EE), depersonalization (DP), and reduced personal accomplishment (PA)-caused by chronic occupational stress. The aim of the current study was to investigate the prevalence of burnout among oncologists in Eastern Europe and to identify the contributing factors. The study was conducted as an online survey between October 2017 and March 2018. Oncologists (including medical, radiation, clinical, and surgical oncologists) from 19 countries were invited to participate. The survey consisted of 30 questions, including the standardized burnout instrument, Maslach Burnout Inventory, and eight demographic questions. Burnout risk was scored according to the scoring manual for health care workers. The study included 637 oncologists. Overall, 28% were at low or intermediate risk and 72% were at high risk for burnout. Forty-four percent of participants were at high risk for EE, 28.7% for DP, and 47.3% for PA. EE risk was associated with female sex. DP risk was highest among clinical and radiation oncologists, whereas PA risk was positively correlated with years of service, percentage of cancer deaths, and availability of the number of oncologists. In multivariate logistic regression analysis, burnout was significantly associated with standardized cancer mortality and fewer years of practice. Burnout among oncologists in Eastern Europe is high, and younger oncologists are the most vulnerable group. Preventive measures should be taken to address this issue, which negatively affects optimal care delivery and poses a threat to oncologists' health and well-being.

Turning point in skin cancer mortality : An analysis of the trend in Germany from 1998 to 2017

Including non-melanocytic types, skin cancer is still the most common cancer in Germany. The objective of this study is to investigate current trends of skin cancer mortality in Germany. Data of the death statistics from 1998 to 2017 were analyzed using joinpoint regression models. Age standardized skin cancer mortality declined since 2013 (annual percentage change -2.1% [95% CI: -4.0 to -0.2%]), while in previous years an increase of +3.4% (95%CI: 1.3 to 5.4%) was observed. The development is mainly driven by adecreasing melanoma mortality. Possible causes of the trend change are especially the nationwide skin cancer screening which was introduced in 2008 and the growing availability of new systemic therapies from about 2011. Further research is needed to estimate the extent of the respective causal contributions.

Colorectal cancer and asbestos exposure-an overview.

The relationship between colorectal cancer and asbestos exposure has not been fully clarified. This study aimed to determine the associations between asbestos exposure and colorectal cancer. We performed a meta-analysis to quantitatively evaluate this association. A fixed effects model was used to summarize the relative risks across studies. Sources of heterogeneity were explored through subgroup analyses and meta-regression. We analyzed the dose-effect relationship using lung cancer standardized mortality ratio (SMR) and the risk of mesothelioma as a percent (%) as exposure surrogates. A total of 47 cohort studies were included. We identified 28 incidence cohort studies from 17 separate papers and extracted colorectal cancer standardized incidence ratio (SIR). Cancer mortality data were extracted from 19 separate cohorts among 13 papers. The overall colorectal cancer SMR for synthesis cohort was 1.07 (95% CI 1.02–1.12). Statistically significant excesses were observed in exposure to mixed asbestos (SMR/SIR=1.07), exposure to production (SMR/SIR=1.11), among asbestos cement workers (SMR/SIR=1.18) and asbestos textile workers (SMR/SIR=1.11). Additionally, we determined that the SMR for lung cancer increased with increased exposure to asbestos, as did the risk for colorectal cancer. This study confirms that colorectal cancer has a positive weak associations with asbestos exposure.

Increased Incidence and Mortality of Gastric Cancer in Immigrant Populations from High to Low Regions of Incidence: A Systematic Review and Meta-Analysis

Gastric cancer is the leading cause of infection-related cancer death and the third-leading cause of cancer death worldwide. The effect of immigration on gastric cancer risk is not well-defined but might be helpful for screening or surveillance endeavors. We performed a systematic review and meta-analysis to define the risk of gastric cancer in immigrants from high-incidence regions to low-incidence regions (including Western Europe, Australia, Brazil, Canada, Israel, and the United States). We searched MEDLINE and EMBASE databases, from January 1980 to January 2019, for studies that identified immigrants from high-incidence regions of gastric cancer, provided clear definitions of immigrant and reference populations, and provided sufficient data to calculate gastric cancer incidence and gastric cancer-related mortality. We performed meta-analyses of standardized incidence ratios (SIR) for first-generation immigrants from high- to low-incidence regions, stratified by immigrant generation, sex, and anatomic and histologic subtype, when data were available. We identified 38 cohort studies that met our inclusion criteria. All 13 studies of 21 distinct populations reported significantly increased SIRs for gastric cancer in first-generation foreign-born immigrants (men SIR range, 1.24-4.50 and women SIR range, 1.27-5.05). The pooled SIR for immigrants with all types of gastric cancer was 1.66 (95% CI, 1.52-1.80) for men and 1.83 (95% CI, 1.69-1.98) for women. Nine studies from 2 high-incidence populations (the former Soviet Union and Japan) reported an increased gastric cancer standardized mortality ratio in first-generation immigrants who migrated to regions of low incidence (former Soviet Union immigrants, 1.44-1.91 for men and 1.40-2.56 for women). Immigrants from regions with a high incidence of gastric cancer to regions of low incidence maintain a higher risk of gastric cancer and related mortality, based on a comprehensive systematic review and meta-analysis. Assessment of immigrant generation along with other risk factors might help identify high-risk populations for prevention and therapeutic interventions.

Trend and projection of mortality rate due to non-communicable diseases in Iran: A modeling study.

BackgroundFollowing the epidemiologic and demographic transition, non-communicable disease mortality is the leading cause of death in Iran. Projecting mortality trend can provide valuable tools for policy makers and planners. In this article, we have estimated the trend of non-communicable disease mortality during 2001–2015 and have projected it until 2030 at national and subnational levels in Iran.MethodsThe data employed was gathered from the Iranian death registration system and using the Spatio-temporal model, the trends of 4 major categories of non-communicable diseases (cancers, cardiovascular diseases, asthma and COPD, and diabetes) by 2030 were projected at the national and subnational levels.ResultsThe results indicated that age standardized mortality rate for cancers, CVDs, and Asthma and COPD will continue to decrease in both sexes (cancers: from 81.8 in 2015 to 45.2 in 2030, CVDs: 307.3 to 173.0, and Asthma and COPD: from 52.1 to 46.6); however, in terms of diabetes, there is a steady trend in both sexes at national level (from 16.6 to 16.5). Age standardized mortality rates for cancers and CVDs, in males and females, were high in all provinces in 2001. The variation between the provinces is clearer in 2015, and it is expected to significantly decrease in all provinces by 2030.ConclusionGenerally, the age standardized mortality rate from NCDs will decrease by 2030. Of course, given the experience of the past two decades in Iran, believing that the mortality rate will decrease may not be an easy notion to understand. However hard to believe, this decrease may be the result of better management of risk factors and early detection of patients due to more comprehensive care in all segments of society, as well as improved literacy and awareness across the country.

Cancer Mortality Trend in Central Italy: Focus on A "Low Rate of Land Use" Area from 1982 to 2011.

The aim of the present study was to estimate total cancer mortality trends from 1982 to 2011 in a “low rate of land use” province of the Latium region (Rieti, central Italy) characterized by a low degree of urbanization, a high prevalence of elderly, and a low number of births. Mortality data of the studied period, provided by the Italian National Institute of Statistics, were used for calculating standardized cancer mortality rates. Trends in mortality were analyzed using Joinpoint regression analysis. Results showed that total standardized cancer mortality rates decreased in the monitored area over the study period. A comparison with other provinces of the same region evidenced that the studied province presented the lowest cancer mortality. The three systems/apparatuses affected by cancer that mainly influenced cancer mortality in the monitored province were the trachea-bronchus-lung, colorectal-anus, and stomach. These findings could be attributed to the implement of preventive initiatives performed in the early 2000s, to healthier environmental scenario, and to lower levels of carcinogenic pollutants in air, water, and soil matrices. Thus, our results indicate that the studied area could be considered a “healthy” benchmark for studies in oncological diseases.

Cancer mortality in Korean workers occupationally exposed to methanol: a cohort study.

Recently, the international agency for research on cancer recommended that methanol should be recognized as a medium-priority, human cancer risk. Therefore, we performed an epidemiological study to evaluate the relationship between methanol exposure and the cancer mortality of Korean workers occupationally exposed to methanol. The study cohort was composed of methanol-exposed 25,218 male workers, data on whom were available from the Korea Occupational Safety and Health Agency; all participants underwent methanol-associated medical check-ups at least once between January 2000 and December 2004. The durations of methanol exposure were categorized as < 10, 10-20, and ≥ 20years. Workplace methanol exposure levels for each worker were divided into three grades. We compared their standardized cancer mortality rates (SMRs) to those of the general population. Intra-cohort hazard ratios were estimated using a Cox's proportional hazards model. We found no positive association between methanol exposure and cancer mortality. In terms of all cancer mortality, methanol-exposed workers exhibited significantly lower SMRs than the general population. In terms of other cancer mortality, no significant difference or trend was evident as a function of duration of methanol exposure. Although we found no significant correlation between methanol exposure and cancer mortality, we believe the work is meaningful; this is the first, large-scale, human epidemiological study. The carcinogenic potential of methanol remains an open question, and studies with longer-term follow-up periods are needed.

Pathogenetic Treatment of Gastritis as a Basis for the Prevention of Gastric Cancer in the Countries of the Commonwealth of Independent States: Literature Review and the Resolution of a Scientific Symposium Held in Minsk, Republic of Belarus, January, 27, 2018

Aim. The aim of this literature review is to generalize existing approaches to the pathogenetic treatment of gastritis as a basis for the prevention of gastric cancer, as well as to submit a resolution of a scientific symposium that brought together gastroenterologists from a number of CIS countries.Background. H. pylori infection is widespread in CIS countries. The proportion of infected adults in the population ranges from 60 % to over 90 %. This causes a high incidence of chronic gastritis and other diseases associated with H. pylori. In 2012, gastric cancer was recognized as the 3rd leading malignant disease in the Kyrgyz Republic and the Republic of Uzbekistan, 5th — in Belarus and Kazakhstan, 6th — in Armenia and the Russian Federation. According to the standardized cancer mortality rate, gastric cancer takes the 1st place in Kyrgyzstan and Uzbekistan, 2nd — in Belarus, 3rd — in Kazakhstan, and 4th — in Armenia and Russia. In every case of H. pylori detection, it is important to make a decision about the expediency of eradication therapy. This is particularly significant, since H. pylori eradication has been recognized as an effective method of gastric cancer prevention. In addition, H. pylori eradication therapy in patients suffering from chronic gastritis with dyspepsia symptoms serves as the firstchoice therapy that allows patients with dyspepsia resulting from H. pylori infection to be excluded. The choice of the H. pylori eradication therapy scheme is determined by the protocols (standards) of patient management accepted in the respective CIS country. A high efficacy of H. pylori infection eradication is shown to be provided by bismuthcontaining schemes.Conclusion. Opportunistic screening of H. pylori is carried out by general practitioners, district physicians, gastroenterologists and other specialists. The most effective method of gastric cancer prevention is the eradication therapy of H. pylori infection in chronic gastritis. The maximal positive potential of such a therapy is realized when it is performed before the atrophic changes of the gastric mucosa have appeared.

Disparities in colorectal cancer mortality across Brazilian States.

To analyze the trend of colorectal cancer mortality adjusted for selected indicators, according to sex, by Brazilian federative units and regions, and countrywide from 1996 to 2012. This is a temporal time series on colorectal cancer mortality rates, using linear regression analysis, in which the independent variable was the centered year. Models were adjusted for selected indicators. There was an increase in standardized colorectal cancer mortality rates for males in all states and for females in 21 states. In the model adjusted for mortality rate from ill-defined causes, for gross domestic product, and for Gini coefficient, the upward trend remained statistically significant (p < 0.05) countrywide only for men, with 0.17 deaths per 100 thousand inhabitants per year (py). In the States of Piauí (0.09 and 0.20 py), Ceará (0.17 and 0.19 py) and Rio Grande do Sul (0.61 and 0.42 py), there was an increase for both men and women, respectively; only among men in the States of Paraíba (0.16 py), Espírito Santo (0.28 py), São Paulo (0.24 py) and Goiás (0.31 py); and among women in Roraima (0.41 py), Amapá (0.97 P/Y), Maranhão (0.10 py), Sergipe (0.46 P/Y), Mato Grosso do Sul (0.47 py), and the Federal District (0.69 py). The increase in colorectal cancer mortality remained significant when assessing Brazil as a whole only among men; in seven States among men, and in nine States among women, regardless of the studied indicators. These differences could be related to the possible increase in incidence and to late access to diagnosis and treatment.

Smoking, alcohol and cancer mortality in Eastern European men: Findings from the PrivMort retrospective cohort study.

Eastern European men have among the highest cancer mortality rates globally. Prevalence of smoking and alcohol intake in this region is also high. The aim of our study was to calculate population attributable risk fraction (PARF) of cancer deaths from smoking and alcohol in Russia, Belarus and Hungary, and to examine the contribution of these lifestyle factors to differences in male cancer mortality in the three countries. Data were collected as part of the PrivMort retrospective cohort study. Randomly selected participants living in mid-size towns in Russia, Belarus and Hungary provided information on smoking habits, alcohol consumption, vital status and cause of death (if applicable) of male relatives (fathers, siblings and partners). PARF of cancer deaths (age 35-79) due to smoking, alcohol consumption and both combined was estimated between 2001 and 2013. Among 72,190 men, 4,702 died of cancer. Age standardized cancer mortality rates were similar to official data in all three countries. The estimated PARF (95% CI) associated with measures of smoking, alcohol consumption, both combined, and overall smoking or drinking were 25% (19-30), 2% (0-4), 29% (19-39), 43% (32-53) in Russia, 18% (8-28), 2% (-1 to 6), 28% (20-35), 38% (25-50) in Belarus and 17% (13-20), 1% (0-3), 25% (20-30), 35% (28-42) in Hungary, respectively. These results suggest that in Eastern Europe, at least one third of cancer deaths in males may have been attributable to smoking and/or alcohol consumption in recent years. Health policies targeting these lifestyle factors can have a major impact on population health.

Adjusting Expected Mortality Rates Using Information From a Control Population: An Example Using Socioeconomic Status.

Expected or reference mortality rates are commonly used in the calculation of measures such as relative survival in population-based cancer survival studies and standardized mortality ratios. These expected rates are usually presented according to age, sex, and calendar year. In certain situations, stratification of expected rates by other factors is required to avoid potential bias if interest lies in quantifying measures according to such factors as, for example, socioeconomic status. If data are not available on a population level, information from a control population could be used to adjust expected rates. We have presented two approaches for adjusting expected mortality rates using information from a control population: a Poisson generalized linear model and a flexible parametric survival model. We used a control group from BCBaSe-a register-based, matched breast cancer cohort in Sweden with diagnoses between 1992 and 2012-to illustrate the two methods using socioeconomic status as a risk factor of interest. Results showed that Poisson and flexible parametric survival approaches estimate similar adjusted mortality rates according to socioeconomic status. Additional uncertainty involved in the methods to estimate stratified, expected mortality rates described in this study can be accounted for using a parametric bootstrap, but this might make little difference if using a large control population.