The Beginning of the Trend Change in Lung Cancer Mortality Trends in Spain, 1980-2018 / El comienzo del cambio de tendencia en las tasas de mortalidad por cáncer de pulmón en España, 1980-2018

BACKGROUND: Recently, some countries have shown stable trends in lung cancer death rates among women not yet described for Spain. We propose to update lung cancer mortality rates in Spain during the period of 1980-2018 by sex and region. METHODS: We used lung cancer mortality (International Classification of Diseases code 162 for the 9th edition, and codes C33 and C34 for 10th edition) and population data from the Spanish National Statistics Institute for the period 1980-2018. Age-standardised mortality rates (ASMRs), all ages and 30-64 years, by region and sex were assessed through joinpoint regression. RESULTS: During the study period lung cancer ASMRs (all ages) in men decreased -0.4% per annum and increased by 3.1% in women. Recently, ASMR (30-64 years) accelerated its decrease (1992-2007; −0.7 and 2007-2018; −3.5%) in men and slowed its increase (1990-2012; 5.7% and 2012-2018; 1.4%) in women. In men, joinpoint analysis detected an initial period in all Autonomous Communities (ACs) in which the rates significantly increased, followed by a second period in which the rates decreased significantly (12 ACs) or remained stable (4 ACs) since the late 1980s or early 1990s. In women, upward trends in ASMRs (all ages) were observed for the whole period in all the ACs. In 13 ACs, an initial period was detected with joinpoint in which the rates remained stable or significantly decreased, followed by a second period in which the rates increased significantly since the late 1980s or early 1990s. CONCLUSIONS: Our study shows gender differences in lung cancer mortality trends in Spain. These differences may be explained by the increased use of tobacco among women and the decreased use among men

ANTECEDENTES: Recientemente, algunos países han mostrado tendencias estables en las tasas de mortalidad por cáncer de pulmón entre las mujeres que aún no se han descrito para España. Proponemos actualizar las tasas de mortalidad por cáncer de pulmón en España durante el período 1980-2018 por sexo y región. MÉTODOS: Utilizamos la mortalidad por cáncer de pulmón (código 162 de la Clasificación Internacional de Enfermedades según la novena edición, y los códigos C33 y C34 según la décima edición) y los datos poblacionales del Instituto Nacional de Estadística de España para el período 1980-2018. Las tasas específicas de mortalidad por edad (TEME), para todas las edades y entre los 30 y 64 años, por región y sexo, se evaluaron mediante el análisis de regresión por segmentos. RESULTADOS: Durante el período de estudio, la TEME (todas las edades) de cáncer de pulmón disminuyó un −0,4% por año en hombres y aumentó un 3,1% en mujeres. Recientemente, la TEME (30-64 años) aceleró su descenso (1992-2007: −0,7% y 2007-2018: −3,5%) en los hombres y desaceleró su aumento (1990-2012: 5,7% y 2012-2018: 1,4%) en las mujeres. En los hombres, el análisis de regresión por segmentos detectó un período inicial en todas las comunidades autónomas (CA) en el que las tasas aumentaron significativamente, seguido de un segundo período en el que las tasas disminuyeron significativamente (12 CA) o se mantuvieron estables (4 CA) desde finales de la década de los ochenta o principios de los noventa. En las mujeres, las tendencias al alza en la TEME (todas las edades) se observaron durante todo el período en todas las CA. En 13 CA, se detectó con el análisis de regresión un período inicial en el que las tasas se mantuvieron estables o disminuyeron significativamente, seguido de un segundo período en el que las tasas aumentaron significativamente desde finales de los años ochenta o principios de los noventa. CONCLUSIONES: Nuestro estudio muestra diferencias de género en las tendencias de mortalidad por cáncer de pulmón en España. Estas diferencias pueden explicarse por el aumento del uso de tabaco en las mujeres y la disminución del uso entre los hombres

Regional differences in colorectal cancer mortality trends, Spain (1980-2018).

INTRODUCTION: the aim of this study was to describe the trends of colorectal cancer (CRC) mortality by autonomous communities (ACs) and gender in Spain (1980-2018). METHODS: the age-standardized mortality rates (ASMRs) for CRC (per 100,000) were calculated by direct standardization, using the world standard population. Mortality trends were described by ACs using a joinpoint regression model in both sexes. The annual percent changes and average annual percentage of change were computed for trends using the joinpoint regression analysis. RESULTS: during the most recent five-year period (2014-2018), the rates decreased among both males and females and were more pronounced in males (-2.3 %) than in females (-1.1 %), although with differences by ACs. ASMRs decrease in both sexes in the Basque Country, Canary Islands, Catalonia, Castile and Leon, Andalusia, Balearic Islands, Madrid, Murcia and Valencia. Whereas in other ACs, it only increases in males (Navarre, Castile-La Mancha, Extremadura and La Rioja) or females (Aragon, Asturias and Galicia). CONCLUSION: this updated analysis of temporal patterns of CRC mortality in Spain from 1980-2018, divided by ACs and sex, shows gender differences in CRC mortality trends. Despite the favorable trends in both sexes, the gender gap is widening.

The Beginning of the Trend Change in Lung Cancer Mortality Trends in Spain, 1980-2018.

BACKGROUND: Recently, some countries have shown stable trends in lung cancer death rates among women not yet described for Spain. We propose to update lung cancer mortality rates in Spain during the period of 1980-2018 by sex and region. METHODS: We used lung cancer mortality (International Classification of Diseases code 162 for the 9th edition, and codes C33 and C34 for 10th edition) and population data from the Spanish National Statistics Institute for the period 1980-2018. Age-standardised mortality rates (ASMRs), all ages and 30-64 years, by region and sex were assessed through joinpoint regression. RESULTS: During the study period lung cancer ASMRs (all ages) in men decreased -0.4% per annum and increased by 3.1% in women. Recently, ASMR (30-64 years) accelerated its decrease (1992-2007; -0.7 and 2007-2018; -3.5%) in men and slowed its increase (1990-2012; 5.7% and 2012-2018; 1.4%) in women. In men, joinpoint analysis detected an initial period in all Autonomous Communities (ACs) in which the rates significantly increased, followed by a second period in which the rates decreased significantly (12 ACs) or remained stable (4 ACs) since the late 1980s or early 1990s. In women, upward trends in ASMRs (all ages) were observed for the whole period in all the ACs. In 13 ACs, an initial period was detected with joinpoint in which the rates remained stable or significantly decreased, followed by a second period in which the rates increased significantly since the late 1980s or early 1990s. CONCLUSIONS: Our study shows gender differences in lung cancer mortality trends in Spain. These differences may be explained by the increased use of tobacco among women and the decreased use among men.

Is the pace of decline in cardiovascular mortality decelerating in Spain?

INTRODUCTION AND OBJECTIVES: To update the information on mortality from cardiovascular diseases and assess recent trends in Spain. METHODS: Deaths from cardiovascular diseases (codes I20-I25, I50, I05-I09, I00-I02, I26-I49, I51, I52, I60-I69, I10-I15, and I70-I79 of the 10th revision of the International Classification of Diseases and Causes of Death) were obtained from the National Statistics Institute. Trends were analyzed using Joinpoint regression models. The results revealed the years (periods) composing each trend, as well as the annual percent change for each of them. The direction and magnitude of recent trends (last available 5-year period) were assessed by using the average annual percent change. RESULTS: The decline in mortality rates from cardiovascular diseases slowed from -3.7% and -4.0% in 1999-2013 to -1.7% and -2.2% since 2013 in men and women, respectively. During the study period (1999-2018) all the analyzed causes decreased significantly. Nevertheless, recent trends differed according to age, sex, and the cause analyzed. Truncated rates (35-64 years) slowed (cardiovascular disease and stroke in men and ischemic heart disease in both sexes), stabilized (cardiovascular disease, stroke, and other heart diseases in women, and blood vessel disease in men), or increased (other diseases of the heart in men and diseases of the blood vessels in women). CONCLUSIONS: In Spain, as in other countries, the reduction in mortality rates from cardiovascular diseases slowed (overall rates for both sexes and truncated in men) or stabilized (truncated rates in women) from 2014 to 2018.

Tendencias divergentes en la mortalidad por suicidio según comunidad autónoma y sexo (1980-2016) / Divergent trends in suicide mortality by Autonomous Community and sex (1980-2016)

OBJETIVOS: Analizar los cambios en las tendencias de la mortalidad por suicidio 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 en los que se produjo un cambio estadísticamente significativo en la tendencia. RESULTADOS: El análisis joinpoint permite diferenciar comunidades en las que las tasas permanecen a lo largo de todo el periodo de estudio estables tanto en hombres (Cantabria, Castilla-La Mancha) como en mujeres (Canarias y Cantabria) y otras con un descenso continuado (Extremadura en hombres y mujeres y Castilla-La Mancha en mujeres). En aquellas comunidades en las que se observan cambios en la tendencia se aprecia, en casi todas ellas, un primer periodo de incremento en las tasas tanto en hombres como en mujeres. Las tendencias más recientes muestran divergencias entre las diferentes comunidades autónomas así, en los hombres, Andalucía, Canarias, Castilla-León, Comunidad Valenciana, Galicia, Murcia, País Vasco y La Rioja muestran tendencias descendentes significativas mientras que Cataluña y Madrid muestran incrementos significativos (2007-2016: 2,4% y 2010-2016: 18,7%, respectivamente). Algo similar se observa en las mujeres, para las que Andalucía, Castilla y León, Comunidad Valenciana, Galicia, Murcia, País Vasco y La Rioja muestran tendencias descendentes mientras que en Baleares, Cataluña y Madrid la tendencia es ascendente (2001-2016: 5,0%; 2006-2016: 4,2% y 2010-2016: 18,7% respectivamente). CONCLUSIONES: La mortalidad por suicidio varía ampliamente a nivel de comunidad autónoma, tanto en términos de nivel de mortalidad como de tendencias. Poco se sabe sobre los determinantes de las tendencias observadas y, por lo tanto, se necesitan más estudios

OBJECTIVES: To analyse the changes in mortality trends by suicide according to Autonomous Community and sex in Spain during the period 1980-2016 using joinpoint regression models. METHODS: Mortality data were obtained from the Instituo Nacional de Estadística. For each Spanish autonomous community and sex, crude and standardised rates were calculated. The joinpoint analysis was used to identify the best-fitting points where a statistically significant change in the trend occurred. RESULTS: The joinpoint analysis allows to differentiate areas in which the rates remain stable in men (Cantabria, Castilla-La Mancha) and women (Canary and Cantabria) throughout the study period and others with a continued decline (Extremadura in both men and women and Castilla-La Mancha in women). In those communities where changes in the trend are observed, in almost all of them, there is a first period of increase in rates in both men and women. The most recent trends show divergences between the different autonomous communities and, in men, Andalusia, the Canary Islands, Castilla-León, the Valencian Community, Galicia, Murcia, the Basque Country and La Rioja show significant downward trends, while Catalonia and Madrid show significant increases (2007-2016: 2.4% and 2010-2016: 18.7% respectively). Something similar is observed in women where Andalusia, Castilla y León, Valencian Community, Galicia, Murcia, País Vasco and La Rioja show downward trends while in the Balearic Islands, Catalonia and Madrid the trend is upward (2001-2016: 5.0%; 2006-2016: 4.2% and 2010-2016: 18.7% respectively). CONCLUSIONS: Suicide mortality varies widely among the Spanish autonomous communities, both in terms of mortality level and trends. Little is known about the determinants of observed trends and, therefore, more studies are needed

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.

Tendencias de la mortalidad por suicidio en España, 1980-2016 / Suicide mortality trends in Spain, 1980-2016

OBJETIVOS: Analizar los cambios en las tendencias de la mortalidad por suicidio en España durante el periodo 1980-2016 utilizando modelos de regresión joinpoint. MÉTODOS: Los datos de mortalidad se obtuvieron del INE. Para cada sexo, las tasas específicas por grupo de edad y estandarizadas (general y truncada) (ASR) se calcularon por el método directo (utilizando la población estándar europea). El análisis joinpoint se utilizó para identificar los puntos más adecuados donde se produjo un cambio estadísticamente significativo en la tendencia. RESULTADOS: La tasa de mortalidad por suicidio ajustada por edad en hombres pasó en el periodo de estudio de 9,8/100.000 varones en 1980 a 11,8 en el año 2016, con un incremento anual medio del 0,8%. En las mujeres, las tasas se incrementaron un 1,0% anual pasando de 2,7/100.000 mujeres en 1980 a 3,7 en 2016. El análisis joinpoint identificó 3 puntos de inflexión en las tasas, tanto en hombres (1986, 2000 y 2010) como en mujeres (1986, 2004 y 2010), que identifican cambios en la tendencia. En el periodo 2010-2016 las tasas se incrementan en las mujeres, mientras que en los hombres las tasas permanecen estables. CONCLUSIONES: Nuestro trabajo muestra un marcado aumento en la mortalidad por suicidio en las mujeres españolas (2010-2016), mientras que en los hombres las tasas permanecen estables. Poco sabemos sobre los determinantes del aumento y, por ello, son necesarios más estudios

OBJECTIVES: To analyse changes in suicide mortality trends in Spain between 1980-2016 using joinpoint regression models. METHODS: Mortality data were obtained from the INE. For each gender, age-group-specific and standardised (overall and truncated) rates (ASR) were calculated by the direct method (using the European standard population). The joinpoint analysis was used to identify the best-fitting points where a statistically significant change in the trend occurred. RESULTS: Age adjusted mortality rates due to suicide in men was 9.8/100,000 males in 1980 and 11.8 in 2016, with an average annual increase of .8%. In women, the rates increased by 1.0% per year from 2.7 women per 100,000 in 1980 to 3.7 in 2016. The joinpoint analysis identified three turning points in the rates for both men (1986, 2000 and 2010) and women (1986, 2004 and 2010), which identify changes in the trend. In the period 2010-2016 the rates increase in women while in men the rates remain stable. CONCLUSIONS: Our work shows a marked increase in mortality by suicide in Spanish women (2010-2016) while in men the rates remain stable. Little is known about the determinants of the increase and, therefore, more studies are needed

Suicide mortality trends in Spain, 1980-2016. / Tendencias de la mortalidad por suicidio en España, 1980-2016.

OBJECTIVES: To analyse changes in suicide mortality trends in Spain between 1980-2016 using joinpoint regression models. METHODS: Mortality data were obtained from the INE. For each gender, age-group-specific and standardised (overall and truncated) rates (ASR) were calculated by the direct method (using the European standard population). The joinpoint analysis was used to identify the best-fitting points where a statistically significant change in the trend occurred. RESULTS: Age adjusted mortality rates due to suicide in men was 9.8/100,000 males in 1980 and 11.8 in 2016, with an average annual increase of .8%. In women, the rates increased by 1.0% per year from 2.7 women per 100,000 in 1980 to 3.7 in 2016. The joinpoint analysis identified three turning points in the rates for both men (1986, 2000 and 2010) and women (1986, 2004 and 2010), which identify changes in the trend. In the period 2010-2016 the rates increase in women while in men the rates remain stable. CONCLUSIONS: Our work shows a marked increase in mortality by suicide in Spanish women (2010-2016) while in men the rates remain stable. Little is known about the determinants of the increase and, therefore, more studies are needed.

Divergent trends in suicide mortality by Autonomous Community and sex (1980-2016). / Tendencias divergentes en la mortalidad por suicidio según comunidad autónoma y sexo (1980-2016).

OBJECTIVES: To analyse the changes in mortality trends by suicide according to Autonomous Community and sex in Spain during the period 1980-2016 using joinpoint regression models. METHODS: Mortality data were obtained from the Instituo Nacional de Estadística. For each Spanish autonomous community and sex, crude and standardised rates were calculated. The joinpoint analysis was used to identify the best-fitting points where a statistically significant change in the trend occurred. RESULTS: The joinpoint analysis allows to differentiate areas in which the rates remain stable in men (Cantabria, Castilla-La Mancha) and women (Canary and Cantabria) throughout the study period and others with a continued decline (Extremadura in both men and women and Castilla-La Mancha in women). In those communities where changes in the trend are observed, in almost all of them, there is a first period of increase in rates in both men and women. The most recent trends show divergences between the different autonomous communities and, in men, Andalusia, the Canary Islands, Castilla-León, the Valencian Community, Galicia, Murcia, the Basque Country and La Rioja show significant downward trends, while Catalonia and Madrid show significant increases (2007-2016: 2.4% and 2010-2016: 18.7% respectively). Something similar is observed in women where Andalusia, Castilla y León, Valencian Community, Galicia, Murcia, País Vasco and La Rioja show downward trends while in the Balearic Islands, Catalonia and Madrid the trend is upward (2001-2016: 5.0%; 2006-2016: 4.2% and 2010-2016: 18.7% respectively). CONCLUSIONS: Suicide mortality varies widely among the Spanish autonomous communities, both in terms of mortality level and trends. Little is known about the determinants of observed trends and, therefore, more studies are needed.

Evolución espaciotemporal del riesgo de mortalidad por suicidio en la España peninsular (1999-2018) / Spatial-temporal evolution of suicide mortality risk in mainland Spain (1999-2018)

INTRODUCCIÓN: El suicidio es un importante problema de salud, cuyas razones subyacentes y patrones de riesgo espaciotemporales no se conocen bien. Este estudio ecológico tuvo como objetivo describir y caracterizar los patrones espaciotemporales del suicidio en la España peninsular durante el período 1999-2018. MÉTODOS: Los datos de mortalidad por suicidios y de población a nivel provincial se obtuvieron del Instituto Nacional de Estadística. Para cada año, provincia y sexo, analizamos los riesgos relativos suavizados (RRs) de mortalidad por suicidio utilizando modelos jerárquicos bayesianos. RESULTADOS: Durante el período de estudio se produjeron 63.307 muertes por suicidio, 47.849 en hombres y 15.458 en mujeres. El riesgo de suicidio durante todo el período de estudio estuvo por encima del promedio nacional para ambos sexos en las provincias de Granada, La Coruña, Lugo y Asturias. En los hombres, esto también ocurrió en Jaén. Los hombres en Madrid y Cantabria, y las mujeres en Madrid, Toledo y Badajoz, mostraron RRs menores de 1 (PP<0,05) durante los 20 años del estudio. El mapa de probabilidades posteriores indica que la mayoría de las provincias en la zona noroeste (Pontevedra, La Coruña, Lugo y Asturias en ambos sexos y León y Orense en mujeres) y el sudeste (Jaén, Málaga, Granada, Almería en ambos sexos, y Córdoba y Ciudad Real en hombres) presentaron riesgos significativamente altos (probabilidades posteriores mayores de 0,95). CONCLUSIONES: Nuestros hallazgos, al identificar áreas donde dirigir programas o estrategias para reducir o eliminar el riesgo de mortalidad por suicidio, muestran la importancia de este tipo de análisis para abordar los problemas de salud pública relacionados con este fenómeno

BACKGROUND: Suicide is a major health problem, whose underlying reasons and spatial-temporal risk patterns are not well understood. This ecological study aims to describe and characterize the spatiotemporal patterns of suicide in mainland Spain during the period 1999-2018. METHODS: Data on mortality from suicide and population at the provincial level were obtained from the National Institute of Statistics. For each year, province, and sex, we analysed the smoothed relative risks (RRs) of suicide mortality using Bayesian hierarchical models. RESULTS: During the study period there were 63,307 suicide deaths, 47,849 in men and 15,458 in women.The risk of suicide throughout the study period is above the national average for both sexes in the provinces of Granada, La Coruña, Lugo and Asturias. In men, this also happens in Jaen. Men in Madrid and Cantabria and women in Madrid, Toledo and Badajoz showed RRs less than 1 (PP<0.05) during the 20 years of the study. The posterior probabilities map indicates that most of the provinces in the Northwest zone (Pontevedra, La Coruña, Lugo and Asturias in both sexes and Leon and Orense in women) and Southeast (Jaen, Malaga, Granada, Almería in both sexes, and Cordoba and Ciudad Real in men) present significantly high risks (posterior probabilities greater than 0.95). CONCLUSIONS: Our findings, identifying areas where to direct programs or strategies to reduce or eliminate the risk of mortality by suicide, show the importance of this type of analysis in addressing public health problems

Gender differences in lung cancer mortality trends in Andalusia 1975-2008: a joinpoint regression analysis.

Death rates from lung cancer in men are higher in Andalusia than in other Spanish regions. This study describes lung cancer mortality rates and their trends in Andalusia from 1975 through 2008. Data on lung cancer mortality were obtained from the Death Registry of Andalusia. For each gender, age group-specific and standardized (overall and truncated) rates were calculated by the direct method using the world standard population. Joinpoint regression analysis was used to identify points where a significant change in trends occurred. In men, short-term trends for age-standardized mortality rates (ASMRs) declined significantly from 2004 through 2008 for each age group < 80 years old. In women, the segmented joinpoint analysis showed a decrease from 1975 through 1998 in ASMRs (overall) (-0.6%, P < 0.05), followed by a marked increase (4.6%, P < 0.05). A decrease in male versus female mortality due to lung cancer is evident in Andalusia (Spain).

Study of colorectal mortality in the Andalusian population / Estudio de mortalidad por cáncer colorrectal en la población andaluza

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 “joinpoints”) 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(AU)

Temporal trends in asthma mortality over 30 years.

BACKGROUND: Bronchial asthma is an important cause of morbidity and mortality worldwide. There is limited availability of updated information on asthma mortality trends. In this context, further investigation of asthma mortality trends is necessary. OBJECTIVE: We aimed to assess trends in asthma mortality trends in the Autonomous Community of Andalusia (over 7 million inhabitants), Spain, during the period 1975-2005. METHOD: Official population estimates and data on asthma deaths were obtained from official authorities. Crude and age-adjusted death rates for different age and gender groups were calculated. Joinpoint regression analysis was used for trend analysis. RESULTS: Age-adjusted death rates for asthma have fallen 2.9% for females and 7.7% for males from 1975 to 2005. This trend has not been constant but has varied during the study period. After a non-significant increase from 1975 to 1981 (4.5% for females and 3.8% for males), adjusted asthma mortality rates have been declining 3.7% for females and 9.6% for males (both p values < 0.05) since 1981. Age-group analysis revealed that the downturn in asthma mortality rates occurred in all age groups above 45 years for males and 35 years for females. CONCLUSIONS: During the last decades, significant variation in asthma mortality was found in Andalusia. This variation has not been constant during the study period. Currently, the decreasing trend initiated in 1981 continues.

[Lung cancer mortality trends in Spain between 1980 and 2005]. / Mortalidad por cáncer de pulmón en España. Evolución en 25 años (1980-2005).

OBJECTIVE: To describe trends in lung cancer mortality in Spain between 1980 and 2005. MATERIAL AND METHODS: Data on deaths from lung cancer during the study period were obtained from the Spanish National Institute of Statistics. Global and truncated (35 to 64 years) age-specific and gender-specific mortality rates were calculated and expressed as rates per 100,000 person-years. Trends were analyzed using joinpoint regression models. RESULTS: In 2005 in Spain, 16 647 men and 2471 women died from lung cancer, accounting for 26.6% and 6.6%, respectively, of all cancer deaths. In men, truncated mortality rates initially increased in the 1980-1992 period (3.1% per year; P<.05) but began to decrease in the 1992-2005 period (-0.8% per year, P<.05). Starting in the 1990s, age-specific mortality rates showed a statistically significant decrease in patients aged less than 85 years. For women, after an initial stable period, truncated mortality rates increased significantly from 1992 onward by 6.3% per year. The analysis by age groups showed that the rates increased in all age groups, except for patients aged 25 to 34 years and patients aged 75 to 84 years, in whom they remained stable. CONCLUSIONS: While lung cancer mortality began to decrease slightly among Spanish men 15 years ago, it increased significantly among women during the same period.

Mortalidad por cáncer de pulmón en España. Evolución en 25 años (1980-2005) / Lung cancer mortality trends in Spain between 1980 and 2005

Objetivo: Describir la evolución de la mortalidad por cáncer de pulmón en España durante el período 1980-2005. Material y métodos: Las defunciones por cáncer de pulmón durante el período de estudio se obtuvieron del Instituto Nacional de Estadística. Se calcularon las tasas específicas globales y truncadas (35-64 años) por grupos de edad y sexo, 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: En 2005 se produjeron en España 16.647 defunciones por cáncer de pulmón en varones y 2.471 en mujeres, lo que representó el 26,6 y el 6,6% de la mortalidad por tumores, respectivamente. En los varones las tasas truncadas, tras un período de incremento (1980-1992, un 3,1% anual; p < 0,05), comienzan a descender (1992-2005, un ­0,8% anual; p < 0,05). Las tasas específicas por grupos de edad muestran un descenso estadísticamente significativo por debajo de los 85 años que comienza en la década de los noventa. En las mujeres las tasas truncadas, tras un período inicial en que permanecen estables, se incrementan significativamente a partir de 1992 un 6,3% anual. El análisis por grupos de edad muestra que las tasas se han incrementado en todos ellos, excepto en los grupos de 25-34 y 75-84 años, donde permanecen estables. Conclusiones: Mientras que la tendencia de mortalidad por cáncer de pulmón en los varones españoles comenzó a descender ligeramente hace 15 años, en las mujeres se observa un aumento llamativo durante el mismo período

Objective: To describe trends in lung cancer mortality in Spain between 1980 and 2005. Material and methods: Data on deaths from lung cancer during the study period were obtained from the Spanish National Institute of Statistics. Global and truncated (35 to 64 years) age­specific and gender­specific mortality rates were calculated and expressed as rates per 100 000 person-years. Trends were analyzed using joinpoint regression models. Results: In 2005 in Spain, 16 647 men and 2471 women died from lung cancer, accounting for 26.6% and 6.6%, respectively, of all cancer deaths. In men, truncated mortality rates initially increased in the 1980-1992 period (3.1% per year; P<.05) but began to decrease in the 1992-2005 period (­0.8% per year, P<.05). Starting in the 1990s, age­specific mortality rates showed a statistically significant decrease in patients aged less than 85 years. For women, after an initial stable period, truncated mortality rates increased significantly from 1992 onward by 6.3% per year. The analysis by age groups showed that the rates increased in all age groups, except for patients aged 25 to 34 years and patients aged 75 to 84 years, in whom they remained stable. Conclusions: While lung cancer mortality began to decrease slightly among Spanish men 15 years ago, it increased significantly among women during the same period

Effect of age, birth cohort and period of death on skin melanoma mortality in Spain, 1975 through 2004.

Recent statistics cohort analysis of mortality reveals that skin melanoma rates are dropping in the younger cohorts. Therefore, the aim of this study is to provide up-to-date information and to analyze recent changes in skin melanoma mortality trends in Spain during the period of 1975-2004 using joinpoint regression and age-period-cohort models. Between 1975 and 2004, the age-standardized (overall) mortality rates for skin melanoma increased from 0.3 to 1.3 per 100,000 person-years for males and from 0.2 to 0.8 per 100,000 person-years for females, with an estimated annual percentage of change of 4.8 and 4.3%, respectively. In men and women, the best fit was found for the full model, which simultaneously considered the effects of age, period and cohort. The risks among both males and females increased in each successive birth cohort born between 1895 and 1950. Thereafter, the risks declined through the most recent birth cohort born in 1970. Examination of the mortality trends by age group and birth cohort revealed that the recent less rapidly rising (men) or stabilizing (women) age-adjusted skin melanoma mortality rates in Spain were a result of declining mortality in the younger age groups and more recent birth cohorts. The particularly favorable trends in young people suggest that a further decline in mortality from skin melanoma in Spain is likely to occur within the next few years.

[Deteriorated health-related quality of life in healthy male smokers]. / Deterioro de la calidad de vida relacionada con la salud en fumadores varones sanos.

OBJECTIVE: To analyze the association between smoking and health-related quality of life (HRQL) in male smokers compared to male nonsmoker, both with no history of chronic disease at 3 health centers in Seville, Spain. PATIENTS AND METHODS: We conducted a retrospective cohort study of smokers and nonsmoker who were matched on the basis of potentially confounding variables (age, marital status, occupation, education, and health center). Data were compiled in interviews conducted by a qualified and previously trained interviewer. HRQL was assessed using the 36-item short form general health questionnaire (SF-36). RESULTS: Except for the physical functioning dimension, which refers to physical activities of daily living (P=.111), smokers had significantly worse (P< .05) HRQL scores measured with the SF-36 questionnaire. On average, smokers scored 10 points less than nonsmoker in the 8 HRQL dimensions. The greatest difference was observed in the dimensions reflecting mental health, particularly in limitations experienced as a consequence of emotional problems (emotional role score 14 points less for smokers; P=.001). When compared to national norms, the scores of smokers were on average 12 points lower in the 8 HRQL dimensions. The greatest differences were observed in physical role (31 points) and bodily pain (17 points). CONCLUSIONS: Even smokers who have not developed acute or chronic comorbidity associated with cigarette smoking have a poorer HRQL than nonsmoker.

Deterioro de la calidad de vida relacionada con la salud en fumadores varones sanos / Deteriorated health-related quality of life in healthy male smokers

Objetivo: Analizar la asociación entre el consumo de tabaco y la calidad de vida relacionada con la salud (CVRS) en varones fumadores y no fumadores sin historia de enfermedad crónica en 3 centros de salud de Sevilla. Pacientes y métodos: Realizamos un estudio de cohortes retrospectivas (fumadores y no fumadores) pareadas en variables que pueden actuar como variables de confusión (edad, estado civil, ocupación, nivel de estudios y centro de salud de referencia). Los datos fueron recogidos mediante entrevista por un encuestador cualificado y previamente entrenado. La CVRS se valoró mediante el cuestionario de salud SF-36. Resultados: Excepto para la dimensión función física, es decir, para el desarrollo de actividades físicas de la vida diaria (p = 0,111), los fumadores presentaron peores puntuaciones (estadísticamente significativas; p < 0,05) en las diferentes dimensiones de la CVRS medidas con el cuestionario SF-36. Los fumadores presentaron en promedio 10 puntos menos en las 8 dimensiones de la CVRS que los no fumadores. La mayor diferencia se observó en dimensiones relacionadas con la salud mental, especialmente con limitaciones debidas a problemas emocionales (diferencia en rol emocional de -­14 puntos; p = 0,001). En comparación con los valores de referencia nacionales, los fumadores presentaron en promedio 12 puntos menos en las 8 dimensiones de la CVRS. Las mayores diferencias se observaron en rol físico (31 puntos) y dolor corporal (17 puntos). Conclusiones: Los fumadores, aun sin presentar comorbilidad aguda o crónica asociada al consumo de tabaco, presentan una peor CVRS que los no fumadores

Objective: To analyze the association between smoking and health-related quality of life (HRQL) in male smokers compared to male nonsmoker, both with no history of chronic disease at 3 health centers in Seville, Spain. Patients and methods: We conducted a retrospective cohort study of smokers and nonsmoker who were matched on the basis of potentially confounding variables (age, marital status, occupation, education, and health center). Data were compiled in interviews conducted by a qualified and previously trained interviewer. HRQL was assessed using the 36-item short form general health questionnaire (SF-36). Results: Except for the physical functioning dimension, which refers to physical activities of daily living (P=.111), smokers had significantly worse (P<.05) HRQL scores measured with the SF-36 questionnaire. On average, smokers scored 10 points less than nonsmoker in the 8 HRQL dimensions. The greatest difference was observed in the dimensions reflecting mental health, particularly in limitations experienced as a consequence of emotional problems (emotional role score 14 points less for smokers; P=.001). When compared to national norms, the scores of smokers were on average 12 points lower in the 8 HRQL dimensions. The greatest differences were observed in physical role (31 points) and bodily pain (17 points). Conclusions: Even smokers who have not developed acute or chronic comorbidity associated with cigarette smoking have a poorer HRQL than nonsmoker

[Trends in lung cancer mortality rates in the provinces of Andalusia, Spain, 1975-2002]. / Evolución de la mortalidad por cáncer de pulmón en las provincias de Andalucía (1975-2002).

OBJECTIVE: To describe trends in lung cancer mortality rates in the different provinces of Andalusia, Spain, from 1975 through 2002. MATERIAL AND METHODS: Deaths from lung cancer during the period 1975 through 2002 were obtained from the Spanish national institute of statistics. Crude rates and age-adjusted rates (overall and truncated 35-64 year rates) were calculated. RESULTS: In Andalusia in 2002 there were 2802 deaths from lung cancer in men and 254 in women, representing 28.4% and 4.5%, respectively, of the mortality rate from tumors. Joinpoint regression analysis distinguished 3 recent trends in truncated (range, 35-64 years) lung cancer mortality rates in men: decrease in Sevilla, increase in Huelva and Jaen, and stability in the other provinces. For women there was a marked increase (5.2% annually) during the period 1988 through 2002 in Malaga. CONCLUSIONS: From a strategic point of view, antismoking strategies should target women in the province of Malaga in particular, with the aim of detaining their increasing risk for this type of cancer and of preventing avoidable and premature deaths among future generations of women.

Evolución de la mortalidad por cáncer de pulmón en las provincias de Andalucía (1975-2002) / Trends in lung cancer mortality rates in the provinces of andalusia, Spain, 1975-2002

Objetivo: Describir la evolución de la mortalidad por cáncer de pulmón en Andalucía durante el período 1975-2002 a nivel provincial. Material y métodos: Las defunciones por cáncer de pulmón durante el período 1975-2002 se obtuvieron del Instituto Nacional de Estadística. Se han calculado los siguientes indicadores: tasas brutas y tasas ajustadas por edad (globales y truncadas 35-64 años). Resultados: En 2002 se produjeron en Andalucía 2.802 defunciones por cáncer de pulmón en varones y 254 en mujeres, lo que representó el 28,4 y el 4,5% de la mortalidad por tumores, respectivamente. El análisis joinpoint permitió delimitar 3 tendencias diferenciadas en los últimos años (descenso en Sevilla, incremento en Huelva y Jaén, y estabilización en el resto de provincias) en las tasas truncadas (35-64 años) de mortalidad por cáncer de pulmón en varones. En las mujeres destacó el fuerte incremento (un 5,2% anual) observado en el período 1988-2002 en Málaga. Conclusiones: Desde el punto de vista estratégico es recomendable que las medidas antitabaco se dirijan especialmente a las mujeres de la provincia de Málaga, con el fin de detener el creciente incremento del riesgo de padecer este tipo de cáncer e impedir muertes evitables y prematuras entre las generaciones futuras de mujeres

Objective: To describe trends in lung cancer mortality rates in the different provinces of Andalusia, Spain, from 1975 through 2002. Material and methods: Deaths from lung cancer during the period 1975 through 2002 were obtained from the Spanish national institute of statistics. Crude rates and age-adjusted rates (overall and truncated 35-64 year rates) were calculated. Results: In Andalusia in 2002 there were 2802 deaths from lung cancer in men and 254 in women, representing 28.4% and 4.5%, respectively, of the mortality rate from tumors. Joinpoint regression analysis distinguished 3 recent trends in truncated (range, 35-64 years) lung cancer mortality rates in men: decrease in Sevilla, increase in Huelva and Jaen, and stability in the other provinces. For women there was a marked increase (5.2% annually) during the period 1988 through 2002 in Malaga. Conclusions: From a strategic point of view, antismoking strategies should target women in the province of Malaga in particular, with the aim of detaining their increasing risk for this type of cancer and of preventing avoidable and premature deaths among future generations of women