Four Decades of COPD Mortality Trends: Analysis of Trends and Multiple Causes of Death.

There is little information on chronic obstructive pulmonary disease (COPD) mortality trends, age of death, or male:female ratio. This study therefore sought to analyze time trends in mortality with COPD recorded as the underlying cause of death from 1980 through 2017, and with COPD recorded other than as the underlying cause of death. We conducted an analysis of COPD deaths in Galicia (Spain) from 1980 through 2017, including those in which COPD was recorded other than as the underlying cause of death from 2015 through 2017. We calculated the crude and standardized rates, and analyzed mortality trends using joinpoint regression models. There were 43,234 COPD deaths, with a male:female ratio of 2.4. Median age of death was 82 years. A change point in the mortality trend was detected in 1996 with a significant decrease across the sexes, reflected by an annual percentage change of -3.8%. Taking deaths into account in which COPD participated or contributed without being the underlying cause led to an overall 42% increase in the mortality burden. The most frequent causes of death when COPD was not considered to be the underlying cause were bronchopulmonary neoplasms and cardiovascular diseases. COPD mortality has decreased steadily across the sexes in Galicia since 1996, and age of death has also gradually increased. Multiple-cause death analysis may help prevent the underestimation of COPD mortality.

Residential radon and lung cancer: a cohort study in Galicia, Spain.

Case-control studies show an association between residential radon and lung cancer. The aim of this paper is to investigate this association through a cohort study. We designed an ambispective cohort study using the Galician radon map, Spain, with controls drawn from a previous case-control study. Subjects were recruited between 2002 and 2009. The data were cross-checked to ascertain lung cancer incidence and then analysed using a Cox regression model. A total of 2,127 subjects participated; 24 lung cancer cases were identified; 76.6% of subjects were drawn from the radon map. The adjusted hazard ratio was 1.2 (95%CI: 0.5-2.8) for the category of subjects exposed to 50Bq/m3 or more. This risk rose when subjects from the case-control study were analyzed separately. In conclusion, we did not observe any statistically significant association between residential radon exposure and lung cancer; however, it appears that with a sample of greater median age (such as participants from the case-control study), the risk of lung cancer would have been higher.

Residential radon and lung cancer: a cohort study in Galicia, Spain / Radón residencial y cáncer de pulmón: un estudio de cohorte en Galicia, España / Radônio residencial e câncer de pulmão: um estudo de coorte na Galícia, Espanha

Case-control studies show an association between residential radon and lung cancer. The aim of this paper is to investigate this association through a cohort study. We designed an ambispective cohort study using the Galician radon map, Spain, with controls drawn from a previous case-control study. Subjects were recruited between 2002 and 2009. The data were cross-checked to ascertain lung cancer incidence and then analysed using a Cox regression model. A total of 2,127 subjects participated; 24 lung cancer cases were identified; 76.6% of subjects were drawn from the radon map. The adjusted hazard ratio was 1.2 (95%CI: 0.5-2.8) for the category of subjects exposed to 50Bq/m3 or more. This risk rose when subjects from the case-control study were analyzed separately. In conclusion, we did not observe any statistically significant association between residential radon exposure and lung cancer; however, it appears that with a sample of greater median age (such as participants from the case-control study), the risk of lung cancer would have been higher.

Los estudios de casos y controles muestran una asociación entre el radón residencial y el cáncer de pulmón. El objetivo del artículo fue investigar esa asociación a través de un estudio de cohorte. Proyectamos un estudio de cohorte ambispectivo, utilizando el mapa de radón de Galicia, España, con los controles obtenidos de un estudio anterior de casos y controles. Los individuos fueron reclutados entre 2002 y 2009. Los datos fueron verificados para confirmar la incidencia de cáncer de pulmón y después analizados con un modelo de regresión de Cox. Participaron un total de 2.127 individuos; se identificaron 24 casos de cáncer de pulmón; un 76,6% de los individuos fueron obtenidos a través del mapa de radón. El hazard ratio ajustado era 1,2 (IC95%: 0,5-2,8) para la categoría de individuos expuestos a 50Bq/m3 o más. El riesgo aumentó cuando los individuos del estudio de casos y controles fueron analizados separadamente. En conclusión, no se observó una asociación estadísticamente significativa entre exposición al radón residencial y cáncer de pulmón; sin embargo, parece que con una muestra con una media de edad más elevada (tales como los participantes del estudio de casos y controles), el riesgo de cáncer de pulmón habría sido más alto.

Estudos de casos e controles mostram uma associação entre radônio residencial e câncer de pulmão. O artigo teve como objetivo investigar essa associação através de um estudo de coorte. Projetamos um estudo ambispectivo coorte, utilizando o mapa de radônio da Galícia, Espanha, com os controles obtidos de um estudo anterior de casos e controles. Os indivíduos foram recrutados entre 2002 e 2009. Os dados foram verificados para confirmar a incidência de câncer de pulmão e depois analisados com um modelo de regressão de Cox. Participaram um total de 2.127 indivíduos; foram identificados 24 casos de câncer de pulmão; 76,6% dos indivíduos foram obtidos através do mapa de radônio. O hazard ratio ajustado era 1,2 (IC95%: 0,5-2,8) para a categoria de indivíduos expostos a 50Bq/m3 ou mais. O risco aumentou quando os indivíduos do estudo de casos e controles foram analisados separadamente. Em conclusão, não foi observada associação estatisticamente significativa entre exposição ao radônio residencial e câncer de pulmão; entretanto, parece que com uma amostra com mediana de idade mais elevada (tais como os participantes do estudo de casos e controles), o risco de câncer de pulmão teria sido mais alto.

Radón residencial y cáncer de pulmón. Un estudio ecológico en Galicia / Residential radon and lung cancer. An ecologic study in Galicia, Spain

Fundamento y objetivo: El radón residencial es la segunda causa de cáncer de pulmón y la primera en sujetos que nunca han fumado. Galicia es un área de alta emisión de radón. El objetivo de este estudio es analizar la correlación entre mortalidad por cáncer de pulmón y exposición a radón residencial en los municipios gallegos. Material y método: Se realizó un estudio ecológico en el que se incluyeron 192 municipios con al menos 3 mediciones de radón residencial cada uno. El número de muertes observadas se obtuvo del Registro de Mortalidad de Galicia, calculándose posteriormente las razones de mortalidad estandarizadas (RME) de cáncer de pulmón para ambos sexos durante el período 1980-2009. Las concentraciones medianas de radón residencial para cada municipio se correlacionaron con las RME por cáncer pulmonar. Resultados: La concentración mediana de radón residencial en los municipios analizados fue de 75 Bq/m3, con un rango intercuartílico de 40,7 a 154 Bq/m3. La correlación entre las RME por cáncer de pulmón y la concentración de radón es significativa para los varones (p = 0,023), mientras que para las mujeres la asociación no alcanza la significación estadística (p = 0,087.) Conclusión: Existe asociación entre el radón residencial y la mortalidad municipal por cáncer de pulmón en Galicia en varones, aunque en las mujeres esta asociación no es estadísticamente significativa. Estos datos evidencian que el radón residencial puede aumentar el riesgo de cáncer de pulmón en varones, aunque en las mujeres no se puede establecer ninguna conclusión (AU)

Background and objective: Residential radon is the second cause of lung cancer and the first in never smokers. Galicia is a high radon emission area. The objective of this study is to analyze the relationship between municipal lung cancer mortality and residential radon in Galician municipalities. Material and method: We performed an ecologic study including 192 municipalities with at least 3 residential radon measurements. The observed number of lung cancer deaths was obtained from the Galician Mortality Registry. Afterwards, we calculated the standardized mortality ratios (SMRs) of lung cancer for males and females for the period comprising 1980-2009. Median municipal residential radon concentrations were correlated with lung cancer SMRs. Results: Median residential radon concentration for the included municipalities was 75 Bq/m3, with an interquartile range of 40.7 to 154 Bq/m3. The correlation between lung cancer SMRs and municipal radon concentration was statistically significant for males (P = .023) whereas it did not reach statistical significance for females (P = .087). Conclusion: There exists an association between municipal residential radon and lung cancer mortality in Galicia for males, though for women the association is not statistically significant. These results suggest that residential radon could raise the risk of lung cancer in males, though for females no association is evident (AU)

[Residential radon and lung cancer. An ecologic study in Galicia, Spain]. / Radón residencial y cáncer de pulmón. Un estudio ecológico en Galicia.

BACKGROUND AND OBJECTIVE: Residential radon is the second cause of lung cancer and the first in never smokers. Galicia is a high radon emission area. The objective of this study is to analyze the relationship between municipal lung cancer mortality and residential radon in Galician municipalities. MATERIAL AND METHOD: We performed an ecologic study including 192 municipalities with at least 3 residential radon measurements. The observed number of lung cancer deaths was obtained from the Galician Mortality Registry. Afterwards, we calculated the standardized mortality ratios (SMRs) of lung cancer for males and females for the period comprising 1980-2009. Median municipal residential radon concentrations were correlated with lung cancer SMRs. RESULTS: Median residential radon concentration for the included municipalities was 75 Bq/m(3), with an interquartile range of 40.7 to 154 Bq/m(3). The correlation between lung cancer SMRs and municipal radon concentration was statistically significant for males (P=.023) whereas it did not reach statistical significance for females (P=.087). CONCLUSION: There exists an association between municipal residential radon and lung cancer mortality in Galicia for males, though for women the association is not statistically significant. These results suggest that residential radon could raise the risk of lung cancer in males, though for females no association is evident.

Lung cancer survival and deletion of GSTM1 and GSTT1 genes. A case-series from Spain.

AIMS AND BACKGROUND: Lung cancer has a high incidence, and only 15% of all cases are alive 5 years after the diagnosis. Identifying the role of the genes implicated in the success of chemotherapy agents is crucial to predict survival. The objective of the study was to assess the effect of GSTM1 and GSTT1 gene deletion on lung cancer survival. METHODS AND STUDY DESIGN: A consecutive sampling of lung cancer cases was performed in 1999-2000 at the University Hospital of Santiago de Compostela, Spain, and GSTM1 and GSTT1 genes were genotyped. The effect of GSTM1 and GSTT1 deletion on survival was analyzed with the logrank test and with Cox regression. RESULTS: A total of 132 individuals were included, and more than half of them had stage IV lung cancer at diagnosis. Survival was similar irrespective of the presence or absence of the GSTM1 gene, whereas those with deleted GSTT1 had a significantly shorter survival. In multivariate Cox regression analysis, no significant effect was observed for the deletion of any of the genes, although there was a tendency towards a worse survival for those with deletion of GSTT1. The main limitation was that stage at diagnosis could not be considered in the analysis since most of the patients were diagnosed at stage IV. CONCLUSIONS: GSTT1 appears to influence lung cancer survival whereas GSTM1 seems to have no effect.

Mortalidad atribuida al consumo de tabaco en Galicia, 1980-2007 / Mortality attributable to tobacco consumption in Galicia (Spain): 1980-2007

Fundamento y objetivo: La estimación de la mortalidad atribuida al consumo de tabaco proporciona una visión complementaria a la prevalencia de consumo y aproxima el impacto que el tabaco tiene en la salud a nivel poblacional. El objetivo de este estudio fue medir el impacto, en cifras de mortalidad, que el consumo de tabaco tuvo en la población gallega mayor de 34 años entre 1980 y 2007, e identificar posibles cambios de tendencia. Pacientes y método: La mortalidad atribuida se estimó aplicando un método independiente de prevalencia basado en el cálculo de fracciones atribuidas poblacionales. Los riesgos relativos y las tasas de mortalidad por cáncer de pulmón en fumadores y nunca fumadores proceden del Cancer Prevention Study-II. Se calcularon tasas anuales de mortalidad atribuida y se analizaron tendencias aplicando modelos de regresión joinpoint.Resultados: A lo largo del período estudiado (1980-2007), se estima que el tabaco ha producido en Galicia 93.308 muertes (87.674 en varones y 5.634 en mujeres). Las tasas de mortalidad atribuida en varones muestran una tendencia decreciente desde mediados de la década de 1990 (porcentaje de cambio anual: -1,8%). En las mujeres la tendencia es creciente desde el bienio 1988-1989 (porcentaje de cambio anual: 28,4%). Conclusiones: El consumo de tabaco ha supuesto en Galicia una importante carga de mortalidad en el período 1980-2007. La tendencia decreciente observada en la mortalidad atribuida al tabaco en varones es un resultado positivo, pero en mujeres jóvenes el aumento de la mortalidad atribuida es alarmante (AU)

Background and ojective: Tobacco attributable mortality offers a complementary view to smoking prevalence, giving an estimate of its impact at population level. The purpose of this study is to measure the impact, using mortality figures, of tobacco consumption in the Galician population over 34 years from 1980 to 2007, and identify any changes of trend. Patients and methods: Attributable mortality was estimated using a prevalence independent method that is based on population attributable fractions. Relative risks and mortality rates due to lung cancer in smokers and non-smokers came from the Cancer Prevention Study-II. Annual attributable mortality rates were calculated and the presence of any trends was tested using joinpoint regression models. Results: During the studied time period (1980-2007) it is estimated that tobacco use has caused 93,308 deaths in Galicia (87,674 in men and 5,634 in women). Attributable mortality rates in men show a decreasing tendency from the middle 90s onwards (annual percent change: -1.8%). However in women there is an increasing trend starting from the period 1988-1989 (annual percent change:28.4%). Conclusions: Tobacco consumption has entailed an important burden of mortality from 1980 to 2007. The decreasing tendency in attributable mortality rates in men is an encouraging result, but its increase in young women is rather alarming (AU)

[Mortality attributable to tobacco consumption in Galicia (Spain): 1980-2007]. / Mortalidad atribuida al consumo de tabaco en Galicia, 1980-2007.

UNLABELLED: BACKGROUND AND OJECTIVE: Tobacco attributable mortality offers a complementary view to smoking prevalence, giving an estimate of its impact at population level. The purpose of this study is to measure the impact, using mortality figures, of tobacco consumption in the Galician population over 34 years from 1980 to 2007, and identify any changes of trend. PATIENTS AND METHODS: Attributable mortality was estimated using a prevalence independent method that is based on population attributable fractions. Relative risks and mortality rates due to lung cancer in smokers and non-smokers came from the Cancer Prevention Study-II. Annual attributable mortality rates were calculated and the presence of any trends was tested using joinpoint regression models. RESULTS: During the studied time period (1980-2007) it is estimated that tobacco use has caused 93,308 deaths in Galicia (87,674 in men and 5,634 in women). Attributable mortality rates in men show a decreasing tendency from the middle 90s onwards (annual percent change: -1.8%). However in women there is an increasing trend starting from the period 1988-1989 (annual percent change:28.4%). CONCLUSIONS: Tobacco consumption has entailed an important burden of mortality from 1980 to 2007. The decreasing tendency in attributable mortality rates in men is an encouraging result, but its increase in young women is rather alarming.

Mortalidad y años de esperanza de vida perdidos a causa del tabaquismo en personas mayores de 35 años en Galicia en el período 2001-2006 / Mortality associated to tobacco consumption in Galicia, Spain. 2001-2006

Fundamento: El tabaquismo es el factor de riesgo susceptiblede ser prevenido que más mortalidad causa en los paísesdesarrollados. El objetivo de este estudio fue medir el impactoen cifras de mortalidad y años de esperanza de vida perdidosque el consumo de tabaco tuvo en la población gallega de 35años y más entre 2001 y 2006.Métodos: La mortalidad atribuida se estimó aplicando unmétodo dependiente de prevalencia basado en el cálculo defracciones atribuidas poblacionales. La prevalencia de consumode tabaco en Galicia se estimó para el periodo 2001-2006a partir de encuestas realizadas en población gallega y los riesgosrelativos proceden del Cancer Prevention Study-II. Se calcularonlos Años de Esperanza de Vida Perdidos por causa deltabaco empleando el método propuesto por Arriaga.Resultados: Entre 2001 y 2006 en Galicia se atribuyeron21.588 muertes al consumo de tabaco en la población de 35años y más, lo que supone el 12,5% de la mortalidad sucedidaen este periodo. El porcentaje de años de esperanza de vidaperdidos como causa del consumo de tabaco descendió del primeral segundo trienio en hombres (28,1% vs 26,8%) yaumentó en mujeres (9,9% vs 10,9%).Conclusiones: La mortalidad atribuida al consumo detabaco se mantiene estable en Galicia en los años estudiados.Esta estabilización podría suceder a expensas de un aumentoligero de la mortalidad en las mujeres jóvenes acompañado deun descenso en los hombres(AU)

Background: In developed countries tobacco smoke is thepreventable risk factor that causes more deaths. The objectiveof this study was to assess the impact of tobacco in the Galicianadult (aged 35 and over) population from 2001 to 2006.Methods: Attributable mortality was estimated by a prevalence-dependent method based on the population attributablefraction. Galician prevalence of tobacco consumption wasestimated for the period 2001-2006 based on local populationsurveys and relative risks derived from the Cancer PreventionStudy-II. Years of life expectancy lost related to tobacco consumptionwere calculated applying the method proposed byArriaga.Results: In Galicia, among 2001 and 2006, 21.588 deathswere attributed to tobacco consumption in the 35-year-oldpopulation and above, which supposes 12,5 % of the mortalityhappened across the period. The percentage of years of lifeexpectancy lost as reason of the consumption of tobacco decreasedfrom the first one to the second triennium in males (28,1% vs 26,8 %) and it increased in females (9,9 % vs 10,9 %).Conclusions: At general population level tobacco attributablemortality shows a stable pattern. This is probably relatedto a slight increase of mortality in young females and a decreasein males’ mortality(AU)