¿Ha dejado de disminuir la mortalidad por enfermedades cerebrovasculares en España? / Has stroke mortality stopped declining in Spain?

Objetivos: Analizar los cambios en las tendencias de la mortalidad por enfermedades cerebrovasculares según comunidad autónoma y sexo en España durante el período 1980-2016 utilizando modelos de regresión joinpoint. Métodos: Los datos de mortalidad se obtuvieron del Instituto Nacional de Estadística. Para cada comunidad autónoma y sexo se calcularon las tasas brutas y estandarizadas. El análisis de regresión joinpoint se utilizó para identificar los puntos más adecuados donde se produjo un cambio estadísticamente significativo en la tendencia. Resultados: El análisis joinpoint permite diferenciar comunidades en las que las tasas muestran un descenso continuado a lo largo de todo el periodo en ambos sexos (Asturias, Cantabria, Castilla y León, Ceuta y Melilla) o solo en los hombres (Extremadura). En los hombres, en las comunidades en las que se observan cambios en la tendencia se aprecia, en todas ellas (excepto en Aragón, Baleares y Murcia, donde las tasas permanecen estables), un primer periodo de descenso, que oscila entre el −3,4% en Cataluña y Extremadura y el −6,0% en Madrid, y un periodo final donde las tasas muestran tendencias divergentes: siguen descendiendo en Andalucía, Aragón, Baleares y Madrid, han comenzado a estabilizarse en Castilla-La Mancha y Murcia y aumentan en Canarias. En las mujeres, en las comunidades en que se observan cambios en la tendencia se aprecia, en todas ellas (excepto en Aragón, Murcia y País Vasco, donde las tasas permanecen estables), un primer periodo de descenso, que oscila entre el −3,1% en Cataluña y el −6,4% en Navarra, y un periodo final donde las tasas muestran tendencias divergentes: siguen descendiendo en Andalucía, Aragón, Cataluña, Galicia, Madrid y País Vasco, han comenzado a estabilizarse en Extremadura y Murcia, y aumentan en Canarias. [...] (AU)

Objectives: To analyse the changes in stroke mortality trends in Spain by autonomous community and by sex during the period 1980-2016, using joinpoint regression models. Methods: Mortality data were obtained from the Spanish National Statistics Institute. Crude and standardised rates were calculated for each Spanish autonomous community, and for each sex. Joinpoint analysis was used to identify the best-fitting points showing a statistically significant change in the trend. Results: Joinpoint analysis enabled us to differentiate between communities in which mortality rates showed a continuous decline throughout the study period in both sexes (Asturias, Cantabria, Castile and Leon, Ceuta, and Melilla) or in men only (Extremadura). In men, in all those communities in which changes in the trend were observed (all but Aragon, the Balearic Islands, and Murcia, where rates remained stable), we observed an initial period of decline (ranging from –3.4% in Catalonia and Extremadura, to –6.0% in Madrid) and a final period where the trends diverged: mortality rates continued to fall in Andalusia, Aragon, the Balearic Islands, and Madrid, but began to stabilise in Castile-La Mancha and Murcia and to increase in the Canary Islands. In women, in those communities where changes were observed (all but Aragon, Murcia, and the Basque Country, where rates remained stable), we observed an initial period of decline (ranging from –3.1% in Catalonia to –6.4% in Navarre) and a final period where divergent trends were observed: rates continued to decline in Andalusia, Aragon, Catalonia, Galicia, Madrid, and the Basque Country, but began to stabilise in Extremadura and Murcia and to increase in the Canary Islands. [...] (AU)

Has stroke mortality stopped declining in Spain?

OBJECTIVES: To analyse the changes in stroke mortality trends in Spain by autonomous community and by sex during the period 1980-2016, using joinpoint regression models. METHODS: Mortality data were obtained from the Spanish National Statistics Institute. Crude and standardised rates were calculated for each Spanish autonomous community, and for each sex. Joinpoint analysis was used to identify the best-fitting points showing a statistically significant change in the trend. RESULTS: Joinpoint analysis enabled us to differentiate between communities in which mortality rates showed a continuous decline throughout the study period in both sexes (Asturias, Cantabria, Castile and Leon, Ceuta, and Melilla) or in men only (Extremadura). In men, in all those communities in which changes in the trend were observed (all but Aragon, the Balearic Islands, and Murcia, where rates remained stable), we observed an initial period of decline (ranging from -3.4% in Catalonia and Extremadura, to -6.0% in Madrid) and a final period where the trends diverged: mortality rates continued to fall in Andalusia, Aragon, the Balearic Islands, and Madrid, but began to stabilise in Castile-La Mancha and Murcia and to increase in the Canary Islands. In women, in those communities where changes were observed (all but Aragon, Murcia, and the Basque Country, where rates remained stable), we observed an initial period of decline (ranging from -3.1% in Catalonia to -6.4% in Navarre) and a final period where divergent trends were observed: rates continued to decline in Andalusia, Aragon, Catalonia, Galicia, Madrid, and the Basque Country, but began to stabilise in Extremadura and Murcia and to increase in the Canary Islands. CONCLUSIONS: Current data show that stroke mortality rates have decreased (in women in Andalusia), stabilised (in both sexes in Murcia, in men in Castile-La Mancha, and in women in Extremadura), and have even reversed (in both sexes in the Canary Islands). Further study is needed to identify the causes of these trends.

Patrón espacial de la mortalidad por EPOC en los municipios de Sevilla (2013-2017) / Spatial pattern of COPD mortality in the municipalities of Seville (2013-2017)

OBJETIVO: analizar el patrón espacial de la mortalidad por EPOC en los municipios de la provincia de Sevilla durante el período 2013-2017. SUJETOS Y MÉTODO: los datos de mortalidad por EPOC y las poblaciones necesarias para el cálculo de los indicadores fueron facilitados por el Instituto de Estadística de Andalucía. Para analizar el patrón espacial de la mortalidad por EPOC a nivel de los municipios de Sevilla se usaron tres estimadores de riesgo: la Razón de Mortalidad Estandarizada (RME), el Riesgo Relativo Suavizado (RRs) y la Probabilidad Posteriores (PP) de que el RRs sea mayor que 1. RESULTADOS: los valores de RRs en los hombres oscilan entre 0,95 en Mairena del Alcor y 1,9 en Badolatosa y El Real de la Jara y en las mujeres los valores oscilan entre 0,78 en La Puebla de Cazalla y 3,4 en Lora del Rio. Se observan 76 municipios en los hombres y 23 en las mujeres con una PP mayor o igual a 0,80. CONCLUSIÓN: nuestros hallazgos ayudan a identificar áreas de alto riesgo para futuros estudios más completos destinados a identificar los factores de riesgo específicos asociados con las áreas críticas observadas y para guiar los esfuerzos de control de la EPOC

OBJECTIVE: to analyze the spatial pattern of COPD mortality in the municipalities of the province of Seville during the 2013-2017 period. SUBJECTS AND METHOD: the COPD mortality data and the populations needed to calculate the indicators were provided by the Andalusian Institute of Statistics. To analyze the spatial pattern of COPD mortality at the level of the municipalities of Seville, three risk estimators were used: Standardized Mortality Ratio (SMR), Relative Risk Smoothing (RRs) and Posterior Probability (PP) that the RRs is greater than 1. RESULTS: RRs values in men range between 0.95 in Mairena del Alcor and 1.9 in Badolatosa and Real de la Jara and in women the values range between 0.78 in La Puebla de Cazalla and 3.4 in Lora del Rio. There are 76 municipalities in men and 23 in women with a PP greater than or equal to 0.80. CONCLUSION: our findings help identify high-risk areas for more complete future studies to identify specific risk factors associated with the critical areas observed and to guide COPD control efforts

Tendencias recientes en cáncer de próstata en España / Recent trends in prostate cancer in Spain

OBJETIVO: Evaluar las tendencias recientes de incidencia, supervivencia y mortalidad por cáncer de próstata en España utilizando datos actualizados. Sujetos y método: Las defunciones por cáncer de próstata se han obtenido del Instituto Nacional de Estadística (INE). Los casos incidentes se han obtenido de las bases de datos Cancer incidence in five continents (CI5) y European Cancer Information System. Para el análisis de tendencias se usaron modelos de regresión joinpoint. En los resultados se muestran los años (período) que componen cada tendencia, así como el porcentaje de cambio anual (PCA) para cada una de ellas. La dirección y magnitud de las tendencias recientes (últimos 5 años disponibles) se evaluaron mediante los porcentajes de cambio anual medio (PCAM). RESULTADOS: Las tasas de incidencia aumentaron de forma significativa, pasando de 16,4 en 1980 a 61,3 en 2014. El análisis joinpoint muestra 3 períodos: 2 iniciales de incrementos significativos (1980-1990; 3,5% y 1990-2004; 8,4%) seguidos de uno final en el que las tasas se estabilizan (2004-2014; -0,5%, no significativo). Las tasas de mortalidad descienden pasando de 12,9 en 1980 a 7,9 en el año 2018, con un PCAM de -1,2% (p < 0,05). Sin embargo, el análisis joinpoint identificó 3 períodos de tiempo: un período inicial de aumento estadísticamente significativo (1980-1998; PCA: 0,6%, p < 0,05) y 2 períodos de disminución en las tasas (1992-2008; PCA: -3,3%, p < 0,05 y 2008-2018; PCA: -2,4%, p < 0,05). CONCLUSIÓN: Las tendencias recientes (últimos 5 años) muestran que las tasas de mortalidad han disminuido y que las tasas de incidencia se han estabilizado e incluso descendido en algunos grupos de edad

OBJECTIVE: To assess recent trends in prostate cancer incidence, survival and mortality in Spain using updated data. Subjects and method: Prostate cancer mortality data have been obtained from the National Institute of Statistics (INE). Incidence cases have been obtained from the databases Cancer Incidence in Five Continents (CI5) and European Cancer Information System. Joinpoint regression models were used for trend analysis. The results show the duration (years) of each trend, as well as the Annual Percent Change (APC) for each of them. The direction and magnitude of recent trends (last 5 years available) were evaluated using the percentages of Average Annual Percent Change (AAPC). RESULTS: Incidence rates increased significantly from 16.4 in 1980 to 61.3 in 2014. The joinpoint analysis shows three periods: two initial periods of significant rise (1980-1990; 3.5% and 1990-2004; 8.4%) followed by a final one in which rates stabilize (2004-2014; -0.5%, non-significant). Mortality rates drop from 12.9 in 1980 to 7.9 in 2018, with an AAPC of -1.2% (p < 0.05). However, the joinpoint analysis identified three time periods: an initial period of statistically significant rise (1980-1998; APC: 0.6%, p < 0.05) and two periods of decreasing rates (1992-2008; APC: -3.3%, p < 0.05 and 2008-2018; APC: -2.4%, p < 0.05). CONCLUSION: Recent trends (last 5 years) show that mortality rates have decreased and incidence rates have stabilized or even decreased in some age groups

Recent trends in prostate cancer in Spain. / Tendencias recientes en cáncer de próstata en España.

OBJECTIVE: To assess recent trends in prostate cancer incidence, survival and mortality in Spain using updated data. SUBJECTS AND METHOD: Prostate cancer mortality data have been obtained from the National Institute of Statistics (INE). Incidence cases have been obtained from the databases Cancer Incidence in Five Continents (CI5) and European Cancer Information System. Joinpoint regression models were used for trend analysis. The results show the duration (years) of each trend, as well as the Annual Percent Change (APC) for each of them. The direction and magnitude of recent trends (last 5 years available) were evaluated using the percentages of Average Annual Percent Change (AAPC). RESULTS: Incidence rates increased significantly from 16.4 in 1980 to 61.3 in 2014. The joinpoint analysis shows three periods: two initial periods of significant rise (1980-1990; 3.5% and 1990-2004; 8.4%) followed by a final one in which rates stabilize (2004-2014; -0.5%, non-significant). Mortality rates drop from 12.9 in 1980 to 7.9 in 2018, with an AAPC of -1.2% (p<0.05). However, the joinpoint analysis identified three time periods: an initial period of statistically significant rise (1980-1998; APC: 0.6%, p<0.05) and two periods of decreasing rates (1992-2008; APC: -3.3%, p<0.05 and 2008-2018; APC: -2.4%, p<0.05). CONCLUSION: Recent trends (last 5 years) show that mortality rates have decreased and incidence rates have stabilized or even decreased in some age groups.

Has stroke mortality stopped declining in Spain? / ¿Ha dejado de disminuir la mortalidad por enfermedades cerebrovasculares en España?

OBJECTIVES: To analyse the changes in stroke mortality trends in Spain by autonomous community and by sex during the period 1980-2016, using joinpoint regression models. METHODS: Mortality data were obtained from the Spanish National Statistics Institute. Crude and standardised rates were calculated for each Spanish autonomous community, and for each sex. Joinpoint analysis was used to identify the best-fitting points showing a statistically significant change in the trend. RESULTS: Joinpoint analysis enabled us to differentiate between communities in which mortality rates showed a continuous decline throughout the study period in both sexes (Asturias, Cantabria, Castile and Leon, Ceuta, and Melilla) or in men only (Extremadura). In men, in all those communities in which changes in the trend were observed (all but Aragon, the Balearic Islands, and Murcia, where rates remained stable), we observed an initial period of decline (ranging from -3.4% in Catalonia and Extremadura, to -6.0% in Madrid) and a final period where the trends diverged: mortality rates continued to fall in Andalusia, Aragon, the Balearic Islands, and Madrid, but began to stabilise in Castile-La Mancha and Murcia and to increase in the Canary Islands. In women, in those communities where changes were observed (all but Aragon, Murcia, and the Basque Country, where rates remained stable), we observed an initial period of decline (ranging from -3.1% in Catalonia to -6.4% in Navarre) and a final period where divergent trends were observed: rates continued to decline in Andalusia, Aragon, Catalonia, Galicia, Madrid, and the Basque Country, but began to stabilise in Extremadura and Murcia and to increase in the Canary Islands. CONCLUSIONS: Current data show that stroke mortality rates have decreased (in women in Andalusia), stabilised (in both sexes in Murcia, in men in Castile-La Mancha, and in women in Extremadura), and have even reversed (in both sexes in the Canary Islands). Further study is needed to identify the causes of these trends.

Análisis de las tendencias en la mortalidad por enfermedades cerebrovasculares en Andalucía (1980-2014) / Analysis of cerebrovascular disease mortality trends in Andalusia (1980-2014)

Introducción: En las últimas décadas las tasas de mortalidad por enfermedades cerebrovasculares (ECV) han descendido de forma importante en muchos países. En este estudio se analizan los cambios recientes en la evolución de la mortalidad por ECV en Andalucía (1980-2014) para verificar si las tendencias observadas previamente por sexo y grupos de edad continúan. Pacientes y métodos: Los datos de mortalidad por ECV y las poblaciones necesarias para el cálculo de los indicadores fueron facilitados por el Instituto Nacional de Estadística. Se calcularon las tasas específicas por grupos de edad y estandarizadas mediante el método directo (población estándar europea). Mediante análisis de regresión «joinpoint» estimamos el porcentaje de cambio anual de las tasas e identificamos puntos de cambio significativos en la tendencia. Además se han estimado las razones de tasas entre Andalucía y España. Resultados: Las tasas estandarizadas en ambos sexos muestran en el análisis joinpoint 3 periodos: un periodo inicial de descenso significativo (1980-1997), un periodo de estabilización en las tasas (1997-2003) y un periodo de marcado descenso significativo (2003-2014). Conclusiones: En el periodo 1997-2003 las tasas de Andalucía se estabilizaron, mientras que a nivel nacional las tasas continuaron descendiendo. Esto determinó un aumento en la brecha entre las tasas de Andalucía y España en ambos sexos y en la mayoría de los grupos de edad

Introduction: In recent decades, mortality rates for cerebrovascular diseases (CVD) have decreased significantly in many countries. This study analyses recent tendencies in CVD mortality rates in Andalusia (1980-2014) to identify any changes in previously observed sex and age trends. Patients and methods: CVD mortality and population data were obtained from Spain's National Statistics Institute database. We calculated age-specific and age-standardised mortality rates using the direct method (European standard population). Joinpoint regression analysis was used to estimate the annual percentage change in rates and identify significant changes in mortality trends. We also estimated rate ratios between Andalusia and Spain. Results: Standardised rates for both males and females showed 3 periods in joinpoint regression analysis: an initial period of significant decline (1980-1997), a period of rate stabilisation (1997-2003), and another period of significant decline (2003-2014). Conclusions: Between 1997 and 2003, age-standardised rates stabilised in Andalusia but continued to decrease in Spain as a whole. This increased in the gap between CVD mortality rates in Andalusia and Spain for both sexes and most age groups

Analysis of cerebrovascular disease mortality trends in Andalusia (1980-2014). / Análisis de las tendencias en la mortalidad por enfermedades cerebrovasculares en Andalucía (1980-2014).

INTRODUCTION: In recent decades, mortality rates for cerebrovascular diseases (CVD) have decreased significantly in many countries. This study analyses recent tendencies in CVD mortality rates in Andalusia (1980-2014) to identify any changes in previously observed sex and age trends. PATIENTS AND METHODS: CVD mortality and population data were obtained from Spain's National Statistics Institute database. We calculated age-specific and age-standardised mortality rates using the direct method (European standard population). Joinpoint regression analysis was used to estimate the annual percentage change in rates and identify significant changes in mortality trends. We also estimated rate ratios between Andalusia and Spain. RESULTS: Standardised rates for both males and females showed 3 periods in joinpoint regression analysis: an initial period of significant decline (1980-1997), a period of rate stabilisation (1997-2003), and another period of significant decline (2003-2014). CONCLUSIONS: Between 1997 and 2003, age-standardised rates stabilised in Andalusia but continued to decrease in Spain as a whole. This increased in the gap between CVD mortality rates in Andalusia and Spain for both sexes and most age groups.

Análisis de las tendencias en la mortalidad por enfermedades cerebrovasculares en España 1980-2011 / Analysis of cerebrovascular mortality trends in Spain from 1980 to 2011

Introducción: En las últimas décadas las tasas de mortalidad por enfermedades cerebrovasculares (ECV) han descendido de forma importante en muchos países. En este estudio se analizan los cambios recientes en la evolución de la mortalidad por ECV en España (1980-2011) para verificar si las tendencias observadas previamente continúan. Pacientes y métodos: Los datos de mortalidad por ECV y las poblaciones necesarias para el cálculo de los indicadores fueron facilitados por el Instituto Nacional de Estadística. Se calcularon las tasas específicas por grupos de edad y estandarizadas globales y truncadas (35-64 años) mediante el método directo (población estándar europea). Mediante análisis de regresión «joinpoint» estimamos el porcentaje de cambio anual de las tasas e identificamos puntos de cambio significativos en la tendencia. Resultados: La mortalidad por ECV se ha reducido de forma contundente y sostenida en los últimos 32 en todos los grupos de edad y sexo en España. En ambos sexos el análisis joinpoint identifica un periodo final de mayor descenso (2005-2011 [-6,3%] en mujeres y 2007-2011 en varones [-7,2%]). Conclusiones: Existe un marcado y continuo descenso en la mortalidad por ECV en España (1980-2011). Teniendo en cuenta el proceso de envejecimiento de la población, es esperable un incremento de la prevalencia y, por ello, de la magnitud de las ECV medida en términos de discapacidad y costes de salud, lo que representará un gran reto para nuestro sistema sanitario

Introduction: In recent decades, mortality rates for cerebrovascular diseases (CVD) have declined significantly in many countries. This study analyses changes in CVD mortality rates in Spain (1980-2011) to determine if previously observed trends remain. Patients and methods: Data on CVD mortality rates and the population data needed for the analysis were provided by Spain's National Statistics Institute. We calculated age-specific mortality rate, age-standardised overall mortality, and age-truncated mortality (35-64 years) using the direct method and standard European population structure. Joinpoint analysis was used to estimate the percentage of annual change in rates and identify significant changes in trends. Results: CVD mortality rate decreased considerably and continuously over the last 32 years in all age groups and in both sexes in Spain. For both sexes, joinpoint analysis identifies a final period with more marked decline: 2005-2011 in women (−6.3%) and 2007-2011 in men (−7.2%). Conclusions: CVD mortality rates displayed a marked and continuous decline in Spain between 1980 and 2011. Due to the ageing of the population, doctors expect an increase in CVD prevalence and therefore its magnitude in terms of disability and healthcare costs, which poses a challenge to our health system

Analysis of cerebrovascular mortality trends in Spain from 1980 to 2011. / Análisis de las tendencias en la mortalidad por enfermedades cerebrovasculares en España 1980-2011.

INTRODUCTION: In recent decades, mortality rates for cerebrovascular diseases (CVD) have declined significantly in many countries. This study analyses changes in CVD mortality rates in Spain (1980-2011) to determine if previously observed trends remain. PATIENTS AND METHODS: Data on CVD mortality rates and the population data needed for the analysis were provided by Spain's National Statistics Institute. We calculated age-specific mortality rate, age-standardised overall mortality, and age-truncated mortality (35-64 years) using the direct method and standard European population structure. Joinpoint analysis was used to estimate the percentage of annual change in rates and identify significant changes in trends. RESULTS: CVD mortality rate decreased considerably and continuously over the last 32 years in all age groups and in both sexes in Spain. For both sexes, joinpoint analysis identifies a final period with more marked decline: 2005-2011 in women (-6.3%) and 2007-2011 in men (-7.2%). CONCLUSIONS: CVD mortality rates displayed a marked and continuous decline in Spain between 1980 and 2011. Due to the ageing of the population, doctors expect an increase in CVD prevalence and therefore its magnitude in terms of disability and healthcare costs, which poses a challenge to our health system.

¿Ha dejado de disminuir la mortalidad por cáncer de próstata en España? / Has prostate cancer mortality stopped its decline in Spain?

Objetivo: Describir la evolución de la mortalidad por cáncer de próstata en España durante el periodo 1980-2013. Sujetos y método: Los datos de mortalidad por cáncer de próstata y las poblaciones necesarias para el cálculo de los indicadores fueron facilitados por el Instituto Nacional de Estadística. Se calcularon las tasas específicas por grupos de edad, crudas y estandarizadas globales mediante el método directo (población estándar europea), que se expresan como tasas por 100.000 personas-año. Para el análisis de tendencias de las tasas se utilizaron modelos de regresión joinpoint. Resultados: Las tasas ajustadas (globales) por edad en España descienden de 21,7 a 15,4 defunciones por 100.000 varones-año entre los años extremos del periodo estudiado (PCA: -0,9%; p < 0,05). El análisis joinpoint refleja 2 periodos: 1980-1998 (incremento del 0,7% anual; p < 0,05) y 1998-2013 en el que las tasas disminuyen de forma significativa (-3%; p < 0,05). Exceptuando las ciudades autónomas de Ceuta y Melilla, en las que las tasas permanecen estables a lo largo del periodo de estudio, el resto de comunidades muestran 1 o 2 puntos de inflexión en las tendencias y todas muestran un periodo final con descenso de las tasas (exceptuando Galicia y Cataluña, en las que en el periodo 2008-2013 se estabilizan). Conclusión: El descenso de la mortalidad por cáncer de próstata en España parece haberse detenido en Galicia y Cataluña

Objective: To describe the evolution of prostate cancer mortality in Spain during the period 1980-2013. Subject and method The prostate cancer mortality data and population data needed to calculate the indicators were provided by the National Institute of Statistics. We calculated the specific rates by age group, raw and standardised globally using the direct method (European standard population). The rates are expressed for 100,000 person-years. For the analysis of trends in the rates, we used joinpoint regression models. Results: The overall rates adjusted for age in Spain decreased from 21.7 to 15.4 deaths per 100,000 men-years between the starting and ending date of the study period (annual percentage change: -.9%; P < .05). The joinpoint analysis reflects 2 periods: 1980-1998 (.7% annual increase; P < .05) and 1998-2013, during which the rates decreased significantly (-3%; P < .05). Except for the autonomous cities of Ceuta and Melilla where the rates remained stable over the course of the study period, the communities showed 1 or 2 points of inflection in the trends, and all had a final period with a reduction in the rates (except for Galicia and Catalonia, where the rates stabilised in 2008-2013). Conclusion: The decline in prostate cancer mortality in Spain appears to have stopped in Galicia and Catalonia

Has prostate cancer mortality stopped its decline in Spain?

OBJECTIVE: To describe the evolution of prostate cancer mortality in Spain during the period 1980-2013. SUBJECT AND METHOD: The prostate cancer mortality data and population data needed to calculate the indicators were provided by the National Institute of Statistics. We calculated the specific rates by age group, raw and standardised globally using the direct method (European standard population). The rates are expressed for 100,000 person-years. For the analysis of trends in the rates, we used joinpoint regression models. RESULTS: The overall rates adjusted for age in Spain decreased from 21.7 to 15.4 deaths per 100,000 men-years between the starting and ending date of the study period (annual percentage change: -.9%; P<.05). The joinpoint analysis reflects 2 periods: 1980-1998 (.7% annual increase; P<.05) and 1998-2013, during which the rates decreased significantly (-3%; P<.05). Except for the autonomous cities of Ceuta and Melilla where the rates remained stable over the course of the study period, the communities showed 1 or 2 points of inflection in the trends, and all had a final period with a reduction in the rates (except for Galicia and Catalonia, where the rates stabilised in 2008-2013). CONCLUSION: The decline in prostate cancer mortality in Spain appears to have stopped in Galicia and Catalonia.

Lung cancer mortality in Spain: estimating the future burden to the year 2028.

OBJECTIVE: To use lung cancer mortality rates from 1979 to 2008 in Andalusia, southern Spain (population >8,000,000), to provide an estimate of the future number of deaths for the period 2009-2028. DESIGN: The numbers of lung cancer deaths from 1979 to 2008 were obtained from the Andalusian Institute for Statistics (AIS). Data were arranged in 5-year age groups using an age-period-cohort model. Age-standardised rates (ASR) per 100, 000 were calculated for males and females. Population projections for Andalusia 2009-2028 were downloaded from the AIS database. RESULTS: In males, the ASR varied from 46.1 in 2004-2008 to 34.6 in 2024-2028, with a projected 33% decrease. In females, the ASR varied from 4.9 in 2004-2008 to 8.9 per 100,000 in 2024-2028, with a projected 45% increase. This reflects an annual change of -1.3% for males and of +2.7% for females for the period 2009-2028. The sex ratio is projected to drop from a male:female ratio of 11 (1979-1983) to 3.8 (2024-2028). CONCLUSIONS: Our projections emphasise the significance of a continuously increasing trend in female lung cancer mortality, with a drop in the projected sex ratio.

Study of colorectal mortality in the Andalusian population.

OBJECTIVES: to provide up-to-date information and to analyze recent changes in colorectal cancer mortality trends in Andalusia during the period of 1980-2008 using joinpoint regression models. PATIENTS AND METHODS: age- and sex-specific colorectal cancer deaths were taken from the official vital statistics published by the Instituto de Estadística de Andalucía for the years 1980 to 2008. We computed age-specific rates for each 5-year age group and calendar year and age-standardized mortality rates per 100,000 men and women. A joinpoint regression analysis was used for trend analysis of standardized rates. Joinpoint regression analysis was used to identify the years when a significant change in the linear slope of the temporal trend occurred. The best fitting points (the "join-points") are chosen where the rate significantly changes. RESULTS: mortality from colorectal cancer in Andalusia during the period studied has increased, from 277 deaths in 1980 to 1,227 in 2008 in men, and from 333 to 805 deaths in women. Adjusted overall colorectal cancer mortality rates increased from 7.7 to 17.0 deaths per 100,000 person-years in men and from 6.6 to 9.0 per 100,000 person-years in women Changes in mortality did not evolve similarly for men and women. Age-specific CRC mortality rates are lower in women than in men, which imply that women reach comparable levels of colorectal cancer mortality at higher ages than men. CONCLUSIONS: sex differences for colorectal cancer mortality have been widening in the last decade in Andalusia. In spite of the decreasing trends in age-adjusted mortality rates in women, incidence rates and the absolute numbers of deaths are still increasing, largely because of the aging of the population. Consequently, colorectal cancer still has a large impact on health care services, and this impact will continue to increase for many more years.

Estimulación de la incidencia de cáncer de pulmón en las mujeres de Andalucía (2001-2004) / Estimation of lung cancer incidence among women from Andalusia (2001-2004)

Objetivo. Estimar la incidencia de cáncer de pulmón en mujeres residentes en Andalucía en el periodo 2001-2004 mediante el análisis de los ingresos que producen. Pacientes y Método. La fuente de información para el análisis de los ingresos fue el Conjunto Mínimo Básico de Datos de Andalucía correspondiente a los años 2000-2004, sobre el que se creo un algoritmo para detectar los casos entre los episodios registrados. Mediante las poblaciones por grupos de edad de cada provincia y el número de casos se calcularon las tasas brutas, las tasas específicas por grupo de edad y las tasas estandarizadas globales y truncadas (35-64 años), usando como estándares la población europea y la mundial. Los resultados se expresaron como casos por 100.000personas-año. Resultados. El número de casos incidentes estimados por los ingresos fueron similares al de fallecimientos para el mismo periodo. En Andalucía, en el periodo 2001-2004 las tasas estandarizadas (población europea) pasaron de 6,2 casos por 100.000 mujeres a 7,6 lo que supone un incremento medio anual del 5,2%. En las tasas truncadas este incremento es del 9,4% pasando las tasas de 8,5 casos por 100.000 mujeres en el año 2001 a 12,3 en el año2004.Conclusiones. Los resultados del presente estudio indican que la incidencia de cáncer de pulmón en mujeres de Andalucía estimado por los ingresos presentó un aumento durante el periodo de estudio

Objective. To estimate the incidence of lung cancer in women from Andalusia for the period 2001-2004 using the information obtained from the admissions they generate. Patients and methods. Data for the analysis of the admissions were obtained from the database “Conjunto Mínimo Básico de Datos de Andalucía” corresponding to the years 2000-2004, creating an algorithm to identify cases among the registered episodes. With the number of cases and the populations of each province brute ratio, age-especific ratios, and global and truncated (35-64yr.) standardised ratios using the direct method (reference population: European and World populations) were estimated. The results were expressed as cases per 100,000 persons-year. Results. The number of incident cases estimated by the admissions was similar to number of deaths for the same period. In Andalusia, standardised ratios changed from 6.2 cases per 100,000 women to 7.6 for the period 2001-2004, which represents an increase of 5.2%. Truncated ratios increased 9.4%, changing from 8.5 cases per 100,000 women to 12.3 for the year 2004.Conclusions. The results of the present study indicate that the incidence of lung cancer in Andalusian women estimated by the admissions experienced an increase during the study period

Estimación de la incidencia de cáncer de pulmón en las mujeres de Andalucía (2001-2004) / Estimation of lung cancer indidence among women form Andalusia (2001-2004)

Objetivo. Estimar la incidencia de cáncer de pulmón en mujeres residentes en Andalucía en el periodo 2001-2004 mediante el análisis de los ingresos que producen. Pacientes y Método. La fuente de información para el análisis de los ingresos fue el Conjunto Mínimo Básico de Datos de Andalucía correspondiente a los años 2000-2004, sobre el que se creo un algoritmo para detectar los casos entre los episodios registrados. Mediante las poblaciones por grupos de edad de cada provincia y el número de casos se calcularon las tasas brutas, las tasas específicas por grupo de edad y las tasas estandarizadas globales y truncadas(35-64 años), usando como estándares la población europea y la mundial. Los resultados se expresaron como casos por 100.000personas-año.Resultados. El número de casos incidentes estimados por los ingresos fueron similares al de fallecimientos para el mismo periodo. En Andalucía, en el periodo 2001-2004 las tasas estandarizadas(población europea) pasaron de 6,2 casos por 100.000 mujeres a 7,6 lo que supone un incremento medio anual del 5,2%. En las tasas truncadas este incremento es del 9,4% pasando las tasas de 8,5 casos por 100.000 mujeres en el año 2001 a 12,3 en el año2004.Conclusiones. Los resultados del presente estudio indican que la incidencia de cáncer de pulmón en mujeres de Andalucía estimado por los ingresos presentó un aumento durante el periodo de estudio (AU)

Objective. To estimate the incidence of lung cancer in women from Andalusia for the period 2001-2004 using the information obtained from the admissions they generate. Patients and methods. Data for the analysis of the admissions were obtained from the database “Conjunto Mínimo Básico de Datos de Andalucía” corresponding to the years 2000-2004, creating an algorithm to identify cases among the registered episodes. With the number of cases and the populations of each province brute ratio, age-especific ratios, and global and truncated (35-64yr.) standardised ratios using the direct method (reference population: European and World populations) were estimated. The results were expressed as cases per 100,000 persons-year. Results. The number of incident cases estimated by the admissions was similar to number of deaths for the same period. In Andalusia, standardised ratios changed from 6.2 cases per 100,000women to 7.6 for the period 2001-2004, which represents an increase of 5.2%. Truncated ratios increased 9.4%, changing from8.5 cases per 100,000 women to 12.3 for the year 2004.Conclusions. The results of the present study indicate that the incidence of lung cancer in Andalusian women estimated by the admissions experienced an increase during the study period (AU)

[Recent changes in prostate cancer mortality in Spain. Trends analysis from 1991 to 2005]. / Cambios recientes en la mortalidad por cáncer de próstata en España: estudio de tendencias en el período 1991-2005.

OBJECTIVE: [corrected] To describe the evolution of prostate cancer mortality in Spain during the period 1991-2005. SUBJECTS AND METHODS: A trend analysis for age standardized mortality rates (European standard population) was performed, using joinpoint regression analysis, which allows estimation of the annual percent change of rates and to find significant changes in such trend. RESULTS: Age standardized mortality rates in Spain reached their peak value in 1996. The joinpoint analysis identified two different periods in the trend of the age standardized rates: a first one of increase in rates between 1991 and 1996 (2.1% annual increase) and a second period starting in 1996, in which rates decline at an annual rate of 2.7%. CONCLUSION: The tendency of prostate cancer seen in Spain resembles that of industrialized areas, with an increase in its age standardized death rates that suffers a downturn by the end of the past decade. Mortality declines for prostate cancer are now evident in 14 out of the 17 Autonomous Communities. Increases in PSA screening and better treatment of early-stage disease, possibly acting in combination, remain plausible hypotheses.

Lung cancer mortality trends by geographical area in Spanish women, 1980-2005.

OBJECTIVE: To provide up-to-date information and analyse recent changes in lung cancer mortality trends among women. DESIGN: The present study analysed subjects by geographical area in Spain during the period 1980-2005 using joinpoint regression models. Age-standardised mortality rates (ASR) for lung cancer were computed from death certificate data obtained from the official authorities in Spain. Joinpoint regression analysis was used to identify the years when significant changes in the linear slope of the temporal trend occurred. RESULTS: The overall ASR changed during the period studied from 5.7 per 100,000 women in 1980 to 8.2/100,000 in 2005, with an average annual increase of 1.7%. Joinpoint regression analysis detected different trends in most Spanish communities. These changes occurred in the late 1980s or early 1990s. ASR among those women aged 35-64 years doubled during the period of study, from 5.6 in 1980 to 11.3 in 2005. CONCLUSIONS: Time trends in lung cancer mortality among women are increasing sharply, especially in the age group 35-64 years, indicating the start of an epidemic phenomenon of lung cancer in women.

Cambios recientes en la mortalidad por cáncer de próstata en España: estudio de tendencias en el período 1991-2005 / Recent changes in prostate cancer mortality in Spain. Trends analysis from 1991 to 2005

Objetivo: Describir la evolución de la mortalidad por cáncer de próstata en España en el periodo 1991-2005. Sujetos y métodos: Realizamos un análisis de tendencia de las tasas estandarizadas de mortalidad (población estándar Europea) mediante análisis de regresión “joinpoint”, el cual nos permite estimar el porcentaje de cambio anual de las tasas y localizar cambios significativos en la tendencia. Resultados: Las tasas de mortalidad estandarizada alcanza su máximo valor en 1996. El análisis “joinpoint” identifica dos periodos diferentes en la tendencia de las tasas estandarizadas: uno inicial de incremento entre 1991 y 1996 (2,1% de incremento anual) y un segúndo periodo comenzando en 1996, en el que las tasas descienden un -2,7% anual. Conclusión: La tendencia de la mortalidad por cancer de prostata en España es similar a la de otras áreas industrializadas, con un incremento en las tasas estandarizadas que sufren un descenso hacia el final de la década pasada. El descenso en la mortalidad por cáncer de próstata es ahora evidente en 14 de las17 Comunidades Autónomas. El incremento del cribaje oportunistico con PSA y una mejora en el tratamiento, posiblemente actuando en combinación, constituye la hipótesis más plausible (AU)

Objetive: To describe the evolution of prostate cancer mortality in Spain during the period 1991-2005. Subjects and methods: A trend analysis for age standardized mortality rates (European standard population) was performed, using joinpoint regression analysis, which allows estimation of the annual percent change of rates and to find significant changes in such trend. Results: Age standardized mortality rates in Spain reached their peak value in 1996. The joinpoint analysis identified two different periods in the trend of the age standardized rates: a first one of increase in rates between 1991 and 1996 (2.1% annual increase) and a second period starting in 1996, in which rates decline at an annual rate of 2.7%.Conclusion: The tendency of prostate cancer seen in Spain resembles that of industrialized areas, with an increase in its age standardized death rates that suffers a downturn by the end of the past decade. Mortality declines for prostate cancer are now evident in 14 out of the 17 Autonomous Communities. Increases in PSA screening and better treatment of early-stage disease, possibly acting in combination, remain plausible hypotheses (AU)