Rising testicular cancer incidence in Spain despite declining mortality: an age-period-cohort analysis.

BACKGROUND: Testicular cancer, primarily affecting young men, has seen an alarming rise globally. This study delves into incidence and mortality trends in Spain from 1990 to 2019 using the Global Burden of Disease (GBD) database and the Age-Period-Cohort (A-P-C) model. METHODS: We analyzed GBD data on testicular cancer cases and deaths in Spain, calculating age-standardized rates (ASIR and ASMR) and employing Joinpoint regression to identify significant shifts. The A-P-C model further dissected the effects of age, period, and birth cohort on these trends. RESULTS: A striking doubling in testicular cancer incidence was observed, from 3.09 to 5.40 per 100,000 men (1.9% annual increase), while mortality rates remained stable and even decreased in younger age groups (0.34 to 0.26 per 100,000, 0.8% annual decrease). Joinpoint analysis revealed four distinct periods of increasing incidence, with a recent slowdown. The A-P-C model highlighted a consistent rise in incidence risk with each successive generation born after 1935, contrasting with a progressive decline in mortality risk across cohorts, particularly marked for those born since the 1960s. CONCLUSION: While mortality rates are encouraging, Spain reflects the global trend of escalating testicular cancer incidence. The A-P-C analysis suggests a generational influence, but the underlying causes remain elusive. Further research is crucial to understand these trends and implement effective prevention strategies to combat this growing health concern.

The influence of age, period, and cohort factors on the incidence of kidney cancer in Spain 1990-2019: Evidence from the global burden of disease study.

OBJECTIVE: This study aimed to assess the influence of age, period, and cohort (A-P-C) factors on kidney cancer (KC) incidence trends in Spain from 1990 to 2019. METHODS: Employing data from the Global Burden of Disease Study 2019, we employed joinpoint analysis to determine long-term patterns and A-P-C modelling to quantify net drift, local drift, longitudinal age curves, and rate ratios (RRs) of period and cohort effects. RESULTS: Over the period 1990-2019, an estimated 142,811 cases of KC were diagnosed in Spain. A consistent upward trend in KC incidence was observed for both men and women, with the male-to-female ratio remaining stable at 2.6. Joinpoint analysis identified three distinct periods for men: An initial period (1990-1995) characterised by a significant increase in rates, a subsequent period (1995-2016) characterised by a slowdown in the rate of increase, and a final period (2016-2019) in which rates have plateaued. In women, 2 time periods were observed: an initial period (1990-2007) in which rates increased significantly, followed by a period of stabilization (2007-2019). Men born in the early-mid 20th century had a rising KC risk, peaking in the 1960s. Women's risk rose steadily, peaking in the late 1990s. CONCLUSION: A-P-C analysis reveals steady KC incidence increase in both genders over three decades. This highlights the need for targeted public health policies and effective prevention strategies.

Mortality rates for Parkinson's disease are increasing in Spain. An age-period-cohort and joinpoint analysis of mortality rates from 1981 to 2020.

BACKGROUND: Mortality in Parkinson's disease is increasing worldwide, but Spanish data need further study. OBJECTIVE: To analyse the mortality trends of Parkinson's disease in Spain between 1981 and 2020. METHODS: This observational retrospective study assessed the Parkinson's disease mortality data from 1981 to 2020 collected from the National Statistics Institute of Spain. Age-standardised mortality rates were analysed by age and sex groups, detecting significant mortality trends through a joinpoint analysis. Age-period-cohort effect and potential years of life lost analyses were conducted. The European standard population of 2013 was considered for the analyses. RESULTS: A total of 88 034 deaths were assessed. The overall age-standardised mortality rate rose throughout the period from 3.67 to 8.57 per 100 000 inhabitants. Mortality rates in men were higher than in women, 11.63 versus 6.57 deaths per 100 000 inhabitants. The sex ratio showed an increase in premature mortality in men during 2020. The overall joinpoint analysis recorded a rise in mortality, primarily since the 20th century, mainly in male and older groups, that matched with a period effect. The age effect was detected, confirming higher mortality at an older age. The analysis of potential years of life lost detected a growth in this rate, changing from 0.66 in 1981 to 1.06 in 2020. CONCLUSIONS: Mortality data for Parkinson's disease in Spain rose significantly in forty years. Mortality rate was higher in the male and age group above 75 years of age. The sex ratio showed premature mortality in men in 2020, which will need further study.

Liver cancer mortality in Mexico: trend analysis from 1998 to 2018 / Mortalidad por cáncer hepático en México: análisis de tendencias de 1998 a 2018

Abstract: Objective: To examine overall, sex, and state-specific liver cancer mortality trends in Mexico. Materials and methods: Joinpoint regression was used to examine the trends in age-standardized mortality rates of liver cancer between 1998-2018. Estimated annual percent change with 95% confidence intervals (95%CI) were computed. Age-period-cohort models were used to assess the effects of age, calendar year, and birth cohort. Results: The state-specific mortality rates ranged from 3.34 (Aguascalientes) to 7.96 (Chiapas) per 100 000 person-years. Sex-specific rates were roughly equal, nationwide. Overall, we observed a statistically significant decrease in liver cancer mortality rates between 1998-2018 (annual percent change, -0.8%; 95%CI -1.0, -0.6). The overall age-period-cohort models suggest that birth cohort may be the most important factor driving the trends. Conclusions: While there was overall decline in liver cancer mortality, differences in rates by region were observed. The regional differences may inform future studies of liver cancer etiology across the country.

Resumen: Objetivo: Examinar la tendencia general, por sexo y estado, de mortalidad por cáncer hepático en México. Material y métodos: Se utilizó regresión joinpoint para examinar las tendencias en las tasas de mortalidad estandarizadas por edad de cáncer hepático (1998-2018). Se estimó el cambio porcentual anual con intervalos de confianza al 95% (IC95%). Se usaron modelos de edad-periodo-cohorte para evaluar el efecto de edad, año calendario y cohorte de nacimiento. Resultados: La mortalidad osciló entre 3.34 (Aguascalientes) y 7.96 (Chiapas) por 100 000 años-persona. La mortalidad por sexo fue relativamente similar a nivel nacional. La mortalidad general disminuyó entre 1998-2018 (cambio porcentual anual, -0.8%; IC95% -1.0, -0.6). La cohorte de nacimiento parece ser el factor más importante que afecta las tendencias. Conclusiones: A pesar de la disminución de mortalidad por cáncer hepático, se observó variación regional en las tasas. Estas diferencias podrían informar estudios futuros sobre la etiología de cáncer hepático en México.

Suicide mortality in Spain (1984-2018): age-period-cohort analysis. / Mortalidad por suicidio en España (1984-2018): análisis edad-período-cohorte.

OBJECTIVE: To assess the effects of age, period and cohort suicide mortality trend in Spain (1984-2018). METHODS: Mortality and population data were obtained from the National Institute of Statistics. The analysis of the effect of age, period of death and birth cohort on the evolution of suicide mortality in the period 1984-2018 was performed using a web tool for age-period-cohort analysis provided by the Division of Cancer Epidemiology and Genetics of the National Cancer Institute of the USA. RESULTS: Rates increase with age (age effect) in both sexes. The period effect shows, in males, an increase over the period 1984-1998 followed by a significant decrease until 2018. In females, rates remain stable over the period 1987-2002, decrease during 2007-2012 (p < 0.05) and eventually stabilise. In both males and females, the risk decreases in each successive birth cohort between 1904 and 1939. Subsequently, the risks increase until the birth cohort of the period 1964-1974 after which the risk decreases for males and remains stable for females. CONCLUSION: A better understanding of the effects of the birth cohort could open new doors in suicide prevention.

Age, Period, and Cohort Effects on Mortality From Ischemic Heart Disease in Southern Spain.

INTRODUCTION AND OBJECTIVES: Ischemic heart disease is the leading cause of death and one of the top 4 causes of burden of disease worldwide. The aim of this study was to evaluate age-period-cohort effects on mortality from ischemic heart disease in Andalusia (southern Spain) and in each of its 8 provinces during the period 1981-2008. METHODS: A population-based ecological study was conducted. In all, 145 539 deaths from ischemic heart disease were analyzed for individuals aged between 30 and 84 years who died in Andalusia in the study period. A nonlinear regression model was estimated for each sex and geographical area using spline functions. RESULTS: There was an upward trend in male and female mortality rate by age from the age of 30 years. The risk of death for men and women showed a downward trend for cohorts born after 1920, decreasing after 1960 with a steep slope among men. Analysis of the period effect showed that male and female death risk first remained steady from 1981 to 1990 and then increased between 1990 and 2000, only to decrease again until 2008. CONCLUSIONS: There were similar age-period-cohort effects on mortality in all the provinces of Andalusia and for Andalusia as a whole. If the observed cohort and period effects persist, male and female mortality from ischemic heart disease will continue to decline.

The changing landscape of religious affiliation in Brazil between 1980 and 2010: age, period, and cohort perspectives / /Um estudo sobre a filiação religiosa no Brasil entre 1980 e 2010: efeitos de idade, período e coorte / /El cambio de panorama de las afiliaciones religiosas en Brasil entre 1980 y 2010: perspectivas de edad, período y cohorte

There has been a remarkable decline in the number of Catholics in Brazil over the last few decades, a fact that is attributed to the growth of Pentecostal churches and to an increase in the number of people with no religious affiliation. We analyzed the age, period, and cohort effects associated with religious affiliation in Brazil from 1980 to 2010, applying the Hierarchical Age-Period-Cohort and Cross-Classified Random Effects Model. We observed that age effects were significant but low for Catholics and Pentecostals, and were substantial for those with no religious affiliation, with a negative relationship. For these first two religious affiliations, period effects were of greater magnitude with clear trends: negative for Catholics and positive for Pentecostals. Cohort effects were significant for all three affiliations, but magnitudes were lower than the other two effects. We also verified that the likelihood of being a Pentecostal decreased with formal education, and the opposite occurred for persons with no religious affiliation. These effects, however, were smaller for younger cohorts, possibly due to the reduced social selectivity of recent students pursuing higher education and the increase in overall levels of education...

Houve uma marcante redução no número relativo de católicos no Brasil nas últimas décadas, fato que é associado, principalmente, ao crescimento das igrejas pentecostais e neopentecostais, bem como ao aumento no número de pessoas sem filiação religiosa. Foram analisados os efeitos de idade, período e coorte associados à filiação religiosa no Brasil entre 1980 e 2010, com o uso do modelo idade-período-coorte hierárquico e modelos de efeitos randômicos com classificação-cruzada. Observaram-se efeitos de idade significativos, mas de pequena magnitude para católicos e pentecostais, e efeitos substanciais para aqueles sem filiação religiosa, sendo essa com uma relação negativa. Para as duas primeiras afiliações, os efeitos de período eram de maior magnitude e com tendências claras: negativa para católicos e positiva para pentecostais. Os efeitos de coorte foram significativos para as três afiliações, mas as magnitudes foram menores do que para dos dois outros efeitos. Também verificou-se que a propensão em ser pentecostal diminui com o nível de educação, sendo que o contrário ocorre para pessoas sem religião. Entretanto, esses efeitos são menos marcantes para coortes mais jovens, possivelmente por causa da natureza menos seletiva da educação superior atualmente no Brasil e do aumento generalizado dos níveis de educação...

Ha ocurrido una notable reducción en el número de católicos en Brasil en las últimas décadas, un hecho que se atribuye al crecimiento de las iglesias pentecostales y un aumento del número de personas sin afiliación religiosa. Analizamos los efectos de edad, período y cohortes asociadas a las afiliaciones religiosas en Brasil desde 1980 hasta 2010, aplicando modelos Jerárquico de Edad-Período-Cohorte y de Efecto Aleatorio de Clasificación Cruzada. Observamos que los efectos de edad fueron significativos pero de baja magnitud para católicos y pentecostales, mientras fueron sustanciales para aquellos sin afiliación religiosa, con una relación negativa. Para las dos primeras afiliaciones religiosas, los efectos de período fueron de mayor magnitud y presentaron tendencias claras: negativas para los católicos y positivas para los pentecostales. Los efectos de cohorte fueron significativos para todas las tres afiliaciones, pero las magnitudes fueron menores que los otros dos efectos. También verificamos que la propensión a ser pentecostal se reduce con la educación formal, y lo opuesto ocurrió con las personas sin afiliación religiosa. Sin embargo, tales efectos fueron menores para cohortes más jóvenes, posiblemente debido a la reducción de la selectividad social de estudiantes recientes en búsqueda de una educación más alta y al aumento general en todos los niveles de educación...

Comparação entre metodologias de idade-período-coorte para o estudo de uma medida da progressão escolar no Brasil / A comparison between age-period-cohort methodologies for an indicator of school progression in Brazil / Comparación entre metodologías de edad-período-cohorte para el estudio de una medición de la progresión escolar en Brasil

Este artigo procura realizar um exercício de comparação metodológica de dois estimadores dos modelos idade-período-coorte: o estimador convencional obtido pelos modelos lineares generalizados restritos (MLGR); e o estimador intrínseco (EI). O objeto de interesse são as contribuições dos efeitos de idade, período e coorte nas mudanças temporais na probabilidade de progressão (PPS) para a 5ª série do ensino fundamental das mulheres brasileiras. A modelagem IPC se justifica uma vez que os efeitos de idade, período e coorte podem impactar de forma significativa a probabilidade de progressão escolar: efeitos de idade refletem tanto a idade mínima de entrada no sistema de ensino como também o dilema entre trabalho e estudo que surge ao longo da carreira educacional; efeitos de período estão associados às diferentes conjunturas econômica e política, bem como ao estado das políticas educacionais; por fim, efeitos de coorte refletem características sociais peculiares a determinados grupos de indivíduos. Os dois instrumentais foram contrapostos em termos da eficiência, significância e estimativa dos parâmetros. Os resultados revelam a potencialidade da solução para o modelo IPC baseada no estimador intrínseco, o qual apresenta parâmetros com variância inferior aos estimados pelo modelo linear generalizado restrito. Desta forma, projeções das PPS baseadas na extrapolação do erro-padrão dos parâmetros obtidos pelo estimador intrínseco podem ser promissoras.

The aim of this article is to conduct a comparative methodological essay of two estimators of age-period-cohort models: the conventional estimator obtained by the generalized linear restricted models (MLGR) and the so-called intrinsic estimator (EI). The objects are contributions of age, period and cohort effects to temporal changes in the progression probability to the 5th grade of elementary school for Brazilian women. The APC modeling is justified because age, period and cohort effects may significantly affect the probability of grade progression: age effects reflect both the minimal age of school entry and the trade-off between study and work; period effects are associated with different economical and political conjunctures, as well as with current educational policies; finally, cohort effects reflect social attributes unique to a group. Both are juxtaposed in terms of the efficiency, significance and parameter estimates. The results reveal the potentiality of the solution to the age-period-cohort model based on intrinsic estimator, which presents parameters with smaller variance than those estimated from generalized linear restricted models. Therefore, projections of grade progression probabilities based on the extrapolation of standard errors of the intrinsic estimator can be promising.

El objetivo de este artículo es realizar un ejercicio de comparación metodológica de dos estimadores de los modelos edad-período-cohorte: el estimador convencional, obtenido por los modelos lineales generalizados restringidos (MLGR), y el estimador intrínseco (EI). El objeto de estudio es la contribución de los efectos de edad, período y cohorte en los cambios temporales dentro de la probabilidad de progresión (PPS) en el 5º curso de la Enseñanza Fundamental de las mujeres brasileñas. El modelo IPC se justifica, ya que los efectos de edad, período y cohorte pueden impactar de forma significativa en la probabilidad de progresión escolar: los efectos de edad se reflejan tanto en la edad mínima de entrada en el sistema de enseñanza, como también en el dilema entre trabajo y estudio que surge a lo largo de la carrera educacional; los efectos del período están asociados a las diferentes coyunturas económicas y políticas, así como al estado de las políticas educacionales; finalmente, los efectos de cohorte reflejan características sociales peculiares de determinados grupos de individuos. Los dos instrumentos fueron contrapuestos en términos de eficiencia, significancia y estimativa de los parámetros. Los resultados de este artículo revelan la potencialidad de una solución para el modelo de IPC basado en el estimador intrínseco, el cual presenta parámetros con variancia inferior a los estimados por el modelo lineal generalizado restringido. De esta forma, proyecciones de las PPS, basadas en la extrapolación del error-padrón de los parámetros obtenidos por el estimador intrínseco, pueden ser prometedoras.

Breast cancer mortality in mexico: an age-period-cohort analysis / Mortalidad por cáncer de mama en méxico: un análisis de edad-periodo-cohorte

OBJECTIVE: To assess the age, period and cohort effects on breast cancer (BC) mortality in Mexico. MATERIAL AND METHODS: Age, period and cohort curvature trends for BC mortality were estimated through the Poisson Regression model proposed by Holford. RESULTS: Nationally, BC death rates have leveled off since 1995 in most age groups. BC mortality trends are mainly determined by birth cohort and age effects in Mexico. Women born between 1940 and 1955 show the highest rate of increase in BC mortality. Women born afterwards still show an increasing trend but at a much lower rate. Mammography and adjuvant therapy have had a limited impact on mortality. Potential reasons for observed patterns are discussed. An increase in BC mortality in Mexico is expected in the following decades. CONCLUSIONS: Mammography screening programs and timely access to effective treatment should be a national priority to reverse the expected increasing BC mortality trend.

OBJETIVO: Evaluar efectos de edad-periodo-cohorte en la mortalidad por cáncer de mama (CaMa) en México. MATERIAL Y MÉTODOS: Las tendencias de los efectos de edad-periodo-cohorte fueron estimados mediante un modelo de regresión de Poisson propuesto por Holford. RESULTADOS: Las tasas de mortalidad por CaMa se han estabilizado en la mayoría de los grupos de edad desde 1995 y están determinadas principalmente por efectos de cohorte y edad. Las mujeres nacidas entre 1940 y 1955 muestran los mayores aumentos en la mortalidad en comparación con las nacidas después de este período. La mamografía y la terapia adyuvante han tenido un impacto limitado sobre la mortalidad. Se discuten posibles explicaciones de las tendencias observadas. En las siguientes décadas se espera continúe aumentando la mortalidad por CaMa. CONCLUSIONES: El acceso a mamografía y a tratamiento oportuno y efectivo debieran ser una prioridad para revertir la tendencia creciente esperada de la mortalidad por CM.