Tendencias de mortalidad por cáncer de mama en Córdoba, Argentina, 1986-2011: algunas interpretaciones sociohistóricas / Trends in mortality from breast cancer in Córdoba, Argentina, 1986-2011: some socio-historical interpretations

OBJETIVO: Analizar e interpretar las tendencias de mortalidad por cáncer de mama (CM) en las últimas décadas en la provincia de Córdoba, Argentina, en función de los cambios demográficos y características del contexto sociopolítico. MÉTODOS: Se calcularon tasas de mortalidad por CM crudas, estandarizadas (método directo) y específicas por edad, para Córdoba, en el período 1986-2011. Mediante la aplicación RiskDiff®, se analizó la variación observada en las tasas crudas entre 1986 y 2011. Se ajustaron modelos de regresión Joinpoint® a las tasas estandarizadas y específicas por grupos etarios. Se consultaron fuentes de datos secundarias (leyes, decretos, programas de salud) para obtener información sobre el contexto sociopolítico del período estudiado. RESULTADOS: La tasa cruda de mortalidad por CM aumentó 24,97% entre 1986 y 2011, siendo esto atribuible a un aumento del riesgo de morir (5,22%), a cambios en la estructura (19,75%) y al tamaño poblacional (39,66%). La tasa estandarizada de mortalidad por CM presentó tendencia creciente hasta 1996 (porcentaje de cambio anual [PCA] = 1,62%; P < 0,05), y luego comienza a descender (PCA = -2,1%; P < 0,05), advirtiéndose una desaceleración alrededor del año 2001. Para las interpretaciones sociohistóricas, se consideraron como ejes de análisis las transiciones demográfica, epidemiológica y sanitaria, así como hechos socioeconómicos y políticos del período estudiado. CONCLUSIONES: El comportamiento de la mortalidad por CM en este período se asocia a factores de índole contextual (demográficos, históricos, económicos, políticos). Los resultados de este trabajo contribuyen a definir acciones y políticas en torno la problemática del CM y en materia del cuidado de salud de las mujeres.

OBJECTIVE: Analyze and interpret trends in mortality from breast cancer in recent decades in the province of Córdoba, Argentina, relative to demographic changes and the sociopolitical context. METHODS: Raw, standardized (direct method), and age-specific mortality from breast cancer was calculated for 1986-2011 in Córdoba. Using RiskDiff® software, variations in the 1986 to 2011 raw rates were analyzed. Joinpoint regression models were adjusted to standardized and specific rates by age group. Secondary data sources (laws, decrees, health programs) were consulted for information on the sociopolitical context of the period. RESULTS: Raw mortality due to breast cancer increased 24.97% from 1986 to 2011, an increase that can be attributed to the increase in the risk of dying (5.22%), to structural changes (19.75%), and to population size (39.66%). Standardized mortality from breast cancer shows a rising trend up to 1996 (annual percentage change [APC] = 1.62%; P <0.05), and then begins to decline (APC = -2.1%; P <0.05), slowing around the year 2001. For socio-historical interpretations, the analysis focused on demographic, epidemiological, and health-related changes, as well as the socioeconomic and political events of the period studied. CONCLUSIONS: The behavior of mortality from breast cancer in this period is associated with contextual factors (demographic, historical, economic, and political). The results of this study will help define actions and policies in breast cancer and women's health care.

Overweight and Obesity in Southern Italy: their association with social and life-style characteristics and their effect on levels of biologic markers / Overweight and Obesity in Southern Italy: their association with social and life-style characteristics and their effect on levels of biologic markers.

BACKGROUND: In the last decades, overweight and obesity have been transformed from minor public health issues to a major threat to public health affecting the most affluent societies and also the less developed ones. OBJECTIVES: To estimate overweight-obesity prevalence in adults, their association with some social determinants and to assess the effect of these two conditions on levels of biologic and biochemical characteristics, by means of a population-based study. METHODS: A random sample of the general population of Putignano was drawn. All participants completed a general pre-coded and a Food Frequency questionnaire; anthropometric measures were taken and a venous blood sample was drawn. All subjects underwent liver ultra-sonography. Data description was done by means of tables and then Quantile Regression was performed. RESULTS: Overall prevalence of overweight and obesity were 34.5

respectively. Both overweight and obesity were more frequent among male, married and low socio-economic position subjects. There were increasing frequencies of normal weight with higher levels of education. Overweight and obese subjects had more frequently Nonalcoholic Fatty Liver Disease, Hypertension and altered biochemical markers. Quantile regression showed a statistically significant association of age with overweight and obesity (maximum about 64.8 yo), gender (female) and low levels of education in both overweight and obesity. More than 10 gr/day of wine intake was associated with overweight. CONCLUSIONS: The prevention and treatment of overweight/obesity on a population wide basis are needed. Population-based strategies should also improve social and physical environmental contexts for healthful lifestyles.

Prostate cancer mortality trends in Argentina 1986-2006: an age-period-cohort and joinpoint analysis / Tendencias en la mortalidad por cáncer de próstata en Argentina 1986-2006: análisis joinpoint y de edad-período-cohorte

The aim of this study was to give an overview of the magnitude, variation by age and time trends in the rates of prostate cancer mortality in Córdoba province and in Argentina as a whole from 1986 to 2006. Mortality data were provided by the Córdoba Ministry of Health and the World Health Organization cancer mortality database. Prostate cancer mortality time trends were analyzed using joinpoint analysis and age-period-cohort models. In Argentina prostate cancer age-standardized mortality rates rose by 1 percent and 3.4 percent per year from 1986 to 1992 and from 1992 to 1998 respectively. There was a decreasing trend (-1.6 percent) for Argentina from 1998 and Córdoba (-1.9 percent) from 1995. Age-period-cohort models for the country and the province showed a strong age effect. In the country there was an increased risk in the 1996-2000 period, whereas there was decreased risk for birth cohorts since 1946, principally in Córdoba. A decreasing trend in prostate cancer mortality was found in Córdoba as well as in Argentina, which might be attributed to the improvement in treatment in this country.

El objetivo de este trabajo fue describir la magnitud, la variación por edad y las tendencias temporales de las tasas de mortalidad por cáncer de próstata en la provincia de Córdoba y en Argentina desde 1986 hasta 2006. Se ajustaron modelos joinpoint y de edad-período-cohorte con los datos de mortalidad del Ministerio de Salud de Córdoba y de la Organización Mundial de la Salud. En Argentina las tasas de mortalidad estandarizada por edad aumentaron 1 por ciento y 3,4 por ciento por año desde 1986 a 1992 y desde 1992 a 1998 respectivamente. Fue estimada una tendencia decreciente (-1.6 por ciento) para Argentina desde 1998 y para Córdoba (-1.9 por ciento) desde 1995. Los modelos edad-período-cohorte tanto para Córdoba, como para el país, mostraron un marcado efecto de edad. En el país se encontró un incremento del riesgo en el período 1996-2000, mientras que las cohortes de nacimiento a partir de 1946 mostraron un riesgo decreciente, principalmente para Córdoba. Se encontró una disminución en las tasas de mortalidad por cáncer de próstata en Córdoba y en Argentina, lo cual podría atribuirse a mejoras en los tratamientos en el país.