Documents

Map_Canc

Description
Cancer geographical distribution in Spain
Categories
Published
of 10
All materials on our website are shared by users. If you have any questions about copyright issues, please report us to resolve them. We are always happy to assist you.
Related Documents
Share
Transcript
  Time trends in municipal distribution patterns of cancer mortality in Spain Gonzalo López-Abente 12 * , Nuria Aragonés 12 , Beatriz Pérez-Gómez 12 , arina Poll!n 12 , a#ier Garc$a-Pérez 12 , %ebeca %amis 12  and Pablo &ern!ndez-Na#arro 12   ã   *Corresponding author: Gonzalo López-Abente glabente@isciii.es    Author Ailiations  1 !n iron#ental and Cancer !pide#iolog$ %nit, &ational Centre or !pide#iolog$, Carlos ''' 'nstitute o (ealth, A da, )onorte de Le#os  2+2, )adrid, pain 2 Consortiu# or /io#edical 0esearch in !pide#iolog$ and ublic (ealth C'/!0 en !pide#iolog3a $ alud 4blica - C'/!0!5, )adrid, pain 6or all author e#ails, please log on.    BMC Cancer   217, '( :8 doi:1.11+917;1-27;-17-8 <he electronic ersion o this article is the co#plete one and can be ound online at:http:===.bio#edcentral.co#17;1-   27;178 0ecei ed: 9 6ebruar$ 217 Accepted: 7 >ul$ 217 ublished: 27 >ul$ 217 ? 217 López-Abente et al. licensee /io)ed Central Ltd. <his is an pen Access article distributed under the ter#s o the Creati e Co##ons Attribution License http:creati eco##ons.orglicensesb$7.5, =hich per#its unrestricted use, distribution, and reproduction in an$ #ediu#,    pro ided the srcinal =orB is properl$ credited. <he Creati e Co##ons ublic o#ain edication =ai er http:creati eco##ons.orgpublicdo#ainzero1.5 applies to the data #ade a ailable in this article, unless other=ise stated. 6or#ula displa$:   Abstract Bac)ground  &e= disease #apping techniDues =idel$ used in s#all-area studies enable disease distribution patterns to be identiied and ha e beco#e eEtre#el$ popular in the ield o public health. <his paper reports on trends in the geographical #ortalit$  patterns o the #ost reDuent cancers in pain, o er a period o 2 $ears. et*ods Fe studied the #unicipal spatial pattern o sto#ach, colorectal, lung, breast, prostate and urinar$ bladder cancer #ortalit$ in pain across our DuinDuennia, spanning the period 1+-2+. Case data =ere broBen do=n b$ to=n +;8 #unicipalities5,  period and seE. !Epected cases or each to=n =ere calculated using reerence rates or each i e-$ear period. 6or #ap  plotting purposes, s#oothed #unicipal relati e risBs =ere calculated using the conditional autoregressi e #odel proposed b$ /esag, orB and )olliH, =ith independent data or each DuinDuenniu#. Fe e aluated the presence o spatial patterns in #aps on the basis o #odels, calculating the ariance in relati e risB corresponding to the structured spatial co#ponent and the unstructured co#ponent, as =ell as the proportion o ariance eEplained b$ the structured spatial co#ponent. %esults  <he #ortalit$ patterns obser ed or sto#ach, colorectal and lung cancer =ere #aintained o er the 2 $ears co ered b$ the stud$. rostate cancer and the tu#ours studied in =o#en sho=ed no deined spatial pattern, =ith the single eEception o sto#ach cancer. <he trend in spatial ractional ariance indicated the possibilit$ o a change in the spatial pattern in breast,  bladder and colorectal cancer in =o#en during the last i e-$ear period. <he paper goes on to discuss =a$s in =hich spatio-te#poral data are depicted in the case o cancer, and re ie= the risB actors that #a$ possibl$ inluence the respecti e tu#oursI spatial patterns. +onclusion 'n #en, the #arBed geographical patterns o sto#ach, colorectal, lung and bladder cancer re#ained stable o er ti#e. /reast, colorectal and bladder cancer in =o#en sho= signs o the possible appearance o a spatial pattern in pain and should thereore be #onitored. ,eyords. isease #apping Cancer #ortalit$ !pide#iolog$ patial epide#iolog$   Bac)ground  &e= disease #apping techniDues =idel$ used in s#all-area studies enable disease distribution patterns to be identiied and ha e beco#e eEtre#el$ popular in the ield o public health J1,2K. Cancer and other disease #ortalit$ atlases J8-K ha e   sho=n that #an$ risB actors o a territorial and thus o an en iron#ental5 nature, inluence geographical patterns. &e= #ethods o anal$sis #aBe it possible to s#ooth selected disease indicators and so re eal their geographical structureJ9K.   !sti#ators obtained in less populated areas share inor#ation =ith neighbouring areas, assu#ing that the$ are eEposed to co##on en iron#ental actors. et, disease incidence and #ortalit$ are d$na#ic processes and thereore ariable in space and ti#e. As a result, dierent spatio-te#poral disease #apping techniDues ha e recentl$ been proposed =ithout an$ broad consensus as to ho= to describe spatio-te#poral disease trends J;-11K.   <he ai# o this stud$ =as to report on trends in geographical #ortalit$ patterns o the #ost reDuent cancers in pain across our DuinDuennia, and in so doing, update the inor#ation published in pre ious studies J12-17K.   et*ods As our case source, =e used indi idual death entries or the period 1+-2+ corresponding to sto#ach cancer 'nternational Classiication o iseases, &inth 0e ision 'C-5 code 11, 'C-1 C195, colorectal cancer 'C-  codes 18-17, 1., 'C-1 code C1+-C215, lung cancer 'C-  code 192, 'C-1 code C88-C875, breast cancer in =o#en 'C-  code 1;7, 'C-1 code C5, prostate 'C-  code 1+, 'C-1 code C915 and bladder cancer 'C-  code 1++, 'C-1 code C9;5. <hese data =ere urnished b$ the &ational tatistics 'nstitute   Instituto Nacional de Estadística  -  INE  5. <he obser ed case data =ere broBen do=n b$ to=n +;8 #unicipalities5 and seE. )unicipal populations, =ith a breaBdo=n  b$ age group 1+ groups5 and seE, =ere obtained ro# the 11 and 21 censuses and the 19 and 29 #unicipal rolls, oicial inor#ation pro ided b$ '&!. <hese $ears corresponded to the #idpoints o the our DuinDuennia co#prising the stud$ period 1+-18, 17-1+, 1-28 and 27-2+5. <he person-$ears or each i e-$ear period =ere obtained  b$ #ultipl$ing these populations b$ . <o calculate eEpected cases, the o erall panish #ortalit$ rates or the abo e our -$ear periods =ere #ultiplied b$ each to=nIs person-$ears, b$ age group and DuinDuenniu#. tandardised #ortalit$ ratios )0s5 =ere calculated as the ratio o obser ed to eEpected deaths. 6or #ap plotting purposes, s#oothed #unicipal relati e risBs 00s5 =ere calculated using the conditional autoregressi e #odel proposed b$ /esag, orB and )olliH /)5 J9K. <his #odel is based on itting a oisson spatial #odel =ith   obser ed cases as the dependent ariable, eEpected cases as oset, and t=o t$pes o rando# eect ter#s =hich taBe the ollo=ing into account: a5 #unicipal contiguit$ spatial ter#  i 5 and b5 #unicipal heterogeneit$ M i 5. N is the intercept Duanti$ing the a erage #ortalit$ rate in all the to=ns. 'n this #odel the linear predictor is: O i PlogQ i 5PNR i R i <he s#oothed 00s or plotting purposes are S   i  P eEp i  R M i 55. A separate #odel =as itted or each period.  Lastl$, in order to ha e an indicator o the presence o a spatial pattern in the #ortalit$ plotted or the respecti e cancers, =e esti#ated the ariance in relati e risB corresponding to the structured spatial co#ponent and the unstructured co#ponent, as =ell as the proportion o ariance eEplained b$ the structured spatial co#ponent J1K. 'ntegrated nested Laplace approEi#ations '&LAs5 =ere used as a tool or /a$esian inerence. 6or this purpose, =e used 0-'&LA J1K =ith the option o si#pliied Laplace esti#ation o the para#eters, a pacBage a ailable in the 0 en iron#ent J19K. A total o +;8 to=ns =ere included, and the spatial data on #unicipal contiguities =as obtained b$  processing the oicial  INE   #aps. !Ea#ples o 0 scripts describing the #odels used to obtain the relati e risB s#oothed #aps and the calculation o the co#ponents o the ariance o spatial ter#s ha e been published else=hereJ1K.   %esults <able 1 sho=s the nu#ber o deaths or the tu#ours studied, b$ seE and i e-$ear period, and the trend in age-adTusted rates !uropean standard population5 J1;K. ata on the nu#ber o deaths are o interest or assessing the igure used to esti#ate   spatial patterns, and the adTusted rates are o interest or assessing the general #ortalit$ trend or each tu#our. )ost o the cancers studied registered a decline in #ortalit$ in the last i e-$ear period, eEcept or: colorectal cancer in #en =hich rose 1.2U in 7 th   ersus the 8 rd  DuinDuenniu#5 and lung and bladder cancer in =o#en =hich rose 2.9U and .9U respecti el$ in 7 th   ersus the 8 rd  DuinDuenniu#5. 6igure 1sho=s the situation o the dierent pro inces in pain. Table '/   0eat*s 1 age-ad2usted rates 34 '5565557 by se46 period and cancer site in Spain   &igure '/   Geograp*ical situation of Spain8s pro#inces and Autonomous %egions 3 Comunidades    Autónomas 7/   Stomac* cancer uring the period 1+-2+, there =ere 177,91 sto#ach cancer-related deaths in pain ;,; in #en and 7+,+11 in =o#en5, accounting or +U o all deaths due to #alignant tu#ours. 6igure 2sho=s the #aps depicting the #unicipal distribution o sto#ach cancer #ortalit$ or each DuinDuenniu#, using the respecti e reerence rates or #en and =o#en. <he pattern pro ed si#ilar or both seEes. <hese #aps clearl$ sho= that the geographical pattern changed er$ little o er the course o the 2 $ears. 'n general, there =as a reduction in the nu#ber o to=ns in the highest 00 categor$. Fhen co#pared to the a erage or pain, areas that #aintained an eEcess risB o d$ing o gastric cancer continued to be large areas o Castile-Leon and to=ns along the Atlantic coast o Galicia, =ith the latter registering higher 00s than those recorded or the  pro inces o /urgos and alencia. &igure 9/   unicipal distribution of relati#e ris) of stomac* cancer mortality in men 3abo#e7 and   omen 3don7 for eac* fi#e-year period6 :ndependent maps for eac* ;uin;uennium/ pain 1+-2+. +olorectal cancer uring the period 1+-2+, there =ere 227,8 deaths due to this cause in pain 128,9 in #en and 1,87 in =o#en5, accounting or 17.U o all deaths due to #alignant tu#ours. 6igure 8 sho=s the #aps depicting the #unicipal distribution o colorectal cancer #ortalit$ or each DuinDuenniu#, using b$ =a$ o reerence the o erall #ortalit$ in each period a#ong #en and =o#en respecti el$. <he geographical pattern =as not er$ pronounced or this cancer and displa$ed #an$ si#ilarities bet=een the seEes. <he #ost characteristic eature =as that the irst i e-$ear period in #en and the irst t=o  i e-$ear periods in =o#en =ere #arBed b$ eEcess #ortalit$ in to=ns in Catalonia and in the pro ince o Leon, a pattern that beca#e attenuated in subseDuent DuinDuennia. &igure </   unicipal distribution of relati#e ris) of colorectal cancer mortality in men 3abo#e7   and omen 3don7 for eac* fi#e-year period6 :ndependent maps for eac* ;uin;uennium/ pain 1+-2+. Lung cancer 6ro# 1+ to 2+ there =ere 872, lung cancer-related deaths in both seEes 87,8 in #en and 8+,2 in =o#en5. <he #unicipal distribution o lung cancer #ortalit$ in #en and =o#en =as er$ dierent 6igure 75. <he geographical pattern in   #en changed relati el$ little o er the 2 $ears o stud$, though the eEcess obser ed in the pro ince o Cadiz beca#e attenuated. <he areas =ith highest #ortalit$ =ere the 0egion o !Etre#adura, eEtensi e areas o =est Andalusia (uel a, e ille and Cadiz5 and to=ns along the sections o the Cantabrian coast corresponding to Asturias and Cantabria. 'n =o#en, there =as hardl$ an$ discernable geographical pattern but so#e to=ns in the pro inces o onte edra and urense registered eEcess #ortalit$ across all our DuinDuennia. &igure (/   unicipal distribution of relati#e ris) of lung cancer mortality in men 3abo#e7 and   omen 3don7 for eac* fi#e-year period6 :ndependent maps for eac* ;uin;uennium/  pain 1+-2+. Breast cancer /et=een 1+ and 2+, there =ere 11,+ deaths due to breast cancer in =o#en in pain, =hich accounted or 1+U o e#ale cancer-related deaths and 7U o o erall e#ale #ortalit$. <here =as no undul$ pronounced breast cancer #ortalit$  pattern 6igure  abo e5, indicating that the risB actors =ere unior#l$ distributed throughout the territor$. uring the irst t=o i e-$ear periods, breast cancer in =o#en plotted an alread$ Bno=n pattern, #arBed b$ to=ns in Catalonia and the /alearic 'sles =ith higher #ortalit$. Although this eEcess #ortalit$ beca#e so#e=hat attenuated =ith ti#e, eEcess #ortalit$ ne ertheless e#erged across =ide s=athes o =est Andalusia, =ith to=ns in (uel a, e ille and Cadiz registering 00s o o er 1.1. <he lo=est #ortalit$ =as recorded or Galicia, south-=est Castile-Leon and east Andalusia. &igure =/   unicipal distribution of relati#e ris) of breast cancer mortality in omen 3abo#e7   and prostate cancer mortality 3don7 for eac* fi#e-year period6 :ndependent maps for eac* ;uin;uennium/  pain 1+-2+. Prostate cancer uring the period 1+-2+, there =ere 17, deaths due to prostate cancer in pain, accounting or 1U o #ortalit$ due to all #alignant tu#ours in #en. <he prostate cancer #ortalit$ pattern =as not at all pronounced 6igure  do=n5,
We Need Your Support
Thank you for visiting our website and your interest in our free products and services. We are nonprofit website to share and download documents. To the running of this website, we need your help to support us.

Thanks to everyone for your continued support.

No, Thanks