Age- and sex-specific spatio-temporal patterns of colorectal cancer mortality in Spain (1975-2008).

In this paper, space-time patterns of colorectal cancer (CRC) mortality risks are studied by sex and age group (50-69, ≥70) in Spanish provinces during the period 1975-2008. Space-time conditional autoregressive models are used to perform the statistical analyses. A pronounced increase in mortality risk has been observed in males for both age-groups. For males between 50 and 69 years of age, trends seem to stabilize from 2001 onward. In females, trends reflect a more stable pattern during the period in both age groups. However, for the 50-69 years group, risks take an upward trend in the period 2006-2008 after the slight decline observed in the second half of the period. This study offers interesting information regarding CRC mortality distribution among different Spanish provinces that could be used to improve prevention policies and resource allocation in different regions.

Evaluating space-time models for short-term cancer mortality risk predictions in small areas.

Current cancer mortality data are available with a delay of roughly three years due to the administrative procedure necessary to create the registries. Therefore, health agencies rely on forecast cancer deaths. In this context, statistical procedures providing mortality/incidence risk predictions for different regions or health areas are very useful. These predictions are essential for defining priorities for cancer prevention and treatment. The main objective of this work is to evaluate the predictive performance of alternative spatio-temporal models for short-term cancer risk/counts prediction in small areas. All the models analyzed here are presented under a general-mixed model framework, providing a unified structure of presentation and facilitating the use of similar tools for computing the prediction mean squared error. Prostate cancer mortality data are used to illustrate the behavior of the different models in Spanish provinces.

Spatio-temporal trends in gastric cancer mortality in Spain: 1975-2008.

AIM OF THE STUDY: There has been a downward trend in gastric cancer mortality worldwide. In Spain, a marked spatial aggregation of areas with excess mortality due to this cause has long been reported. This paper sought to analyse the evolution of gastric cancer mortality risk in Spanish provinces and explore the possible attenuation of the geographical pattern. METHODS: We studied a series of gastric cancer mortality data by province, year of death, sex and age group using a conditional autoregressive (CAR) model that incorporated space, time and spatio-temporal interactions. RESULTS: Gastric cancer mortality risk decreased in all Spanish provinces in both males and females. Overall, decreasing trends were more pronounced during the first years of the study period, largely due to a sharper fall in gastric cancer mortality risk among the older population. Recent decades have witnessed a slowing in the rate of decrease, especially among the younger age groups. In most areas, risk declined at a similar rate, thus serving to maintain interprovincial differences and the persistence of the geographical pattern, though with some differences. The north and northwest provinces were the areas with higher mortality risks in both sexes and age groups over the entire study period. CONCLUDING STATEMENT: Despite the decline in gastric cancer mortality risk observed for the 50 Spanish provinces studied, geographical differences still persist in Spain, and the cluster of excess mortality in the north-west of the country remains in evidence.

Age-specific spatio-temporal patterns of female breast cancer mortality in Spain (1975-2005).

PURPOSE: In recent decades, a decline in breast cancer mortality has been observed across Europe, and also in Spain. Our objective is to assess the spatio-temporal pattern during the period 1975-2005 by specific age groups (<45, 45-64, ≥65) in the Spanish provinces. METHODS: For each age group, a spatio-temporal P-spline model with a B-spline basis is used to smooth the mortality risks. Smoothing is carried out in three dimensions: longitude, latitude, and time, allowing for a different time evolution of both spatial components. The age-specific decline is calculated as the maximum of the estimated curve in each province. A confidence band for each curve is also provided. RESULTS: For the first age group (<45), the decline in the different provinces is observed between 1986 and 1991. For women aged between 45 to 64 years, the change occurs between 1990 and 1993. For the third age group (≥65), change points range from 1992 to 2000, unlike Malaga and Cadiz where the change has not been observed in the studied period. Northern and some Mediterranean provinces are the areas with higher mortality risks for all the age groups. CONCLUSIONS: A different behavior for breast cancer mortality risks is observed for different provinces among the age specific groups. The decline of mortality is delayed for the oldest age group. Province differences in the implementation of screening programs could explain some of the observed differences.

A cohort study to estimate occupational mortality risks in Navarra.

BACKGROUND: Few studies on occupational mortality have been conducted in Spain. The objective of this work was to analyse inequalities on global mortality and on mortality due to specific causes according to occupation in a historical cohort of males from the province of Navarra, Spain. METHODS: The base population for this historical cohort comprised all employed men over age 34 from Navarra in the 1986 population register. Age-standardised point estimates and confidence intervals for occupational-specific mortality risks were computed. RESULTS: There exist differences in mortality risks with respect to the overall risk of Navarra in certain occupational activities for several major causes of mortality. Some of the results corroborate previous findings in other works, such as the significant high risk that presents in leather, clothing workers and shoemakers when analysing kidney, bladder and other urinary malignant tumours, while others present a certain degree of novelty. CONCLUSION: This work contributes to filling the gap in the lack of works on occupational mortality in Spain. It also complements the information that other monitoring systems may provide on occupational health.