Changing trends of diseases in Eastern Europe: closing the gap

EUROPEAN CANCER MORTALITY PREDICTIONS FOR THE YEAR 2023 WITH FOCUS ON LUNG CANCER

BACKGROUND

We aimed to predict cancer mortality figures for 2023 for the European Union (EU-27), its five most populous countries, and the UK. We focused on mortality from lung cancer.

MATERIALS AND METHODS

Using cancer death certifications and population data from the World Health Organization and EUROSTAT databases for 1970-2018 we predicted numbers of deaths and age-standardized rates (ASR) for 2023 for all cancers combined and the ten most common cancer sites. We investigated the changes in trends over the observed period. The number of avoided deaths over the period 1989-2023 were estimated for all cancers as well as lung cancer.

RESULTS

We predicted 1,261,990 cancer deaths for 2023 in the EU-27, corresponding to ASRs of 123.8/100,000 men (-6.5% vs 2018) and 79.3 for women (-3.7%). Over 1989-2023, about 5,862,600 million cancer deaths were avoided in the EU-27 compared with peak rates in 1988. Most cancers displayed favourable predicted rates, with the exceptions of pancreatic cancer, that was stable in EU men (8.2/100,000) and rose 3.4% in EU women (5.9/100,000), and female lung cancer which however tends to level off (13.6/100,000). Steady declines are predicted for colorectal, breast prostate, leukemia, stomach in both sexes and male bladder cancers. The focus on lung cancer showed falls in mortality for all age groups in men. Female lung cancer mortality declined in the young -35.8% (ASR 0.8/100,000) and middle aged (-7%, ASR: 31.2/100,000) but still increased 10% in the elderly (65+ years).

CONCLUSION

The advancements in tobacco control are reflected in favorable lung cancer trends, and should be pushed further. Greater efforts on the control of overweight and obesity, alcohol consumption, infection and related neoplasms, together with improvements in screening, early diagnosis and treatments may achieve a further 35% reduction on cancer mortality in the EU by 2035.

European Groundshot-addressing Europe's cancer research challenges: a Lancet Oncology Commission

Cancer research is a crucial pillar for countries to deliver more affordable, higher quality, and more equitable cancer care. Patients treated in research-active hospitals have better outcomes than patients who are not treated in these settings. However, cancer in Europe is at a crossroads. Cancer was already a leading cause of premature death before the COVID-19 pandemic, and the disastrous effects of the pandemic on early diagnosis and treatment will probably set back cancer outcomes in Europe by almost a decade. Recognising the pivotal importance of research not just to mitigate the pandemic today, but to build better European cancer services and systems for patients tomorrow, the Lancet Oncology European Groundshot Commission on cancer research brings together a wide range of experts, together with detailed new data on cancer research activity across Europe during the past 12 years. We have deployed this knowledge to help inform Europe's Beating Cancer Plan and the EU Cancer Mission, and to set out an evidence-driven, patient-centred cancer research roadmap for Europe. The high-resolution cancer research data we have generated show current activities, captured through different metrics, including by region, disease burden, research domain, and effect on outcomes. We have also included granular data on research collaboration, gender of researchers, and research funding. The inclusion of granular data has facilitated the identification of areas that are perhaps overemphasised in current cancer research in Europe, while also highlighting domains that are underserved. Our detailed data emphasise the need for more information-driven and data-driven cancer research strategies and planning going forward. A particular focus must be on central and eastern Europe, because our findings emphasise the widening gap in cancer research activity, and capacity and outcomes, compared with the rest of Europe. Citizens and patients, no matter where they are, must benefit from advances in cancer research. This Commission also highlights that the narrow focus on discovery science and biopharmaceutical research in Europe needs to be widened to include such areas as prevention and early diagnosis; treatment modalities such as radiotherapy and surgery; and a larger concentration on developing a research and innovation strategy for the 20 million Europeans living beyond a cancer diagnosis. Our data highlight the important role of comprehensive cancer centres in driving the European cancer research agenda. Crucial to a functioning cancer research strategy and its translation into patient benefit is the need for a greater emphasis on health policy and systems research, including implementation science, so that the innovative technological outputs from cancer research have a clear pathway to delivery. This European cancer research Commission has identified 12 key recommendations within a call to action to reimagine cancer research and its implementation in Europe. We hope this call to action will help to achieve our ambitious 70:35 target: 70% average 10-year survival for all European cancer patients by 2035.

Patterns in age and cause of death contribution to the sex gap in life expectancy: a comparison among ten countries

Women live longer than men and the absolute difference between male and female mortality risk reaches its maximum at old ages. We decomposed the sex gap in life expectancy and investigated the changes over time of the profile of the age–cause specific contributions with indicators of location, magnitude and dispersion in ten countries. Data were retrieved from the Human Cause-of-Death Database. The decomposition analyses revealed that neoplasm, heart diseases and external causes were the main drivers of the gender gap. We also find two main patterns in the development of age-specific contributions. With mortality delay, regarding neoplasm-related mortality and heart disease-related mortality, the shift (i.e., movement of the modal age at contribution towards older ages) and compression (i.e., dispersion concentrated on a shorter age interval) of the survival advantage of women over a narrower age range reveal that men are gradually improving their survival. This might be linked to improvements in survival, diagnosis and access to treatment, at least to those ages no longer affected by the most significant differences.

Breaking a Path by Creating a New One – How Organizational Change Boosts Children’s Cancer Care

The theory of organizational path dependence helps us to understand why organizational change is sometimes extremely difficult, if not impossible. Although recent conceptualizations of path dependence allow for strategic agency, the theory is still underspecified regarding how to break an organizational path. In an attempt to develop the theory in this regard, we make use of a case in the sphere of global health with an undisputed life-saving impact. More precisely, we trace a significant improvement in the field of pediatric cancer care back to path-breaking organizational change: the successful introduction of multi¬center cooperation within a health-care system that is arguably locked-into a centralization path. Drawing on longitudinal research conducted within Russian hospitals, we conclude that path-breaking change is an intricate process based upon distinct activities, and supported by mechanisms, directed towards the creation of a new organizational path.

Mortality convergence in the enlarged European Union: a systematic literature review

Background

The high mortality rates in the European Union (EU) Member States that acceded in 2004 sparked political interest in mortality convergence. Whether mortality is converging in the EU remains unclear. We reviewed the literature on mortality convergence in the post-2004 EU territory as a whole. We also explored whether the study designs influenced the results and whether any determinants of mortality convergence had been empirically examined.

Methods

A systematic literature review was performed. Our search included scientific databases and the websites of international governmental institutions and European demographic research institutes.

Results

We uncovered 94 unique records and included seven studies that reported on 36 analyses. There was marked methodological heterogeneity, including in the convergence measures (beta and sigma convergence). All of the beta convergence analyses found narrowing mortality differentials, whereas most of the sigma convergence analyses found widening mortality differentials. The results are robust to the units of analysis and mortality and dispersion measures. Our results also suggest that there is a lack of evidence on the determinants of mortality convergence in the EU.

Conclusions

There is general agreement that the EU regions and the Member States with high initial mortality rates improved the fastest, but this trend did not lead to overall mortality convergence in the EU. The harmonization of mortality convergence measures and research into determinants of mortality convergence are needed to support future EU cohesion policy. Policy-makers should consider supporting areas that have moderate but stagnant mortality rates, in addition to those with high mortality rates.

Standard Expected Years of Life Lost Due to Malignant Neoplasms in Poland, 2000-2014

The aim of the study was an analysis of mortality trends due to malignant neoplasms in Poland. The study material was a database, consisting of 1,367,364 death certificates of inhabitants of Poland who died during the period 2000-2014 due to malignant cancer. To calculate years of life lost, the SEYLLp index (Standard Expected Years of Life Lost per living person) was applied. We also calculated AAPC (Average Annual Percentage Change). The SEYLLp index (per 10,000 population) due to malignant neoplasms in Poland in males decreased from 586.3 in 2000 to 575.5 in 2014, whereas in females it increased from 398.6 in 2000 to 418.3 in 2014. The greatest number of lost years of life in 2014 was attributed to lung cancer (174.7 per 10,000 males and 77.3 per 10,000 females), breast cancer in females (64.5) and colorectal cancer in males (39.0). The most negative trends were observed for lung cancer in females (AAPC = 3.5%) and for colorectal cancer (AAPC = 1.8%) and prostate cancer (AAPC = 1.6%) in males. Many lost years could have been prevented by including a greater number of Polish inhabitants in screening examinations, mostly targeted at malignant neoplasm, whose incidence is closely connected with modifiable risk factors.

Impact of obesity on life expectancy among different European countries: secondary analysis of population-level data over the 1975-2012 period

OBJECTIVE

This study assesses the impact of obesity on life expectancy for 26 European national populations and the USA over the 1975-2012 period.

DESIGN

Secondary analysis of population-level obesity and mortality data.

SETTING

European countries, namely Austria, Belarus, Belgium, the Czech Republic, Denmark, Estonia, Finland, France, Hungary, Iceland, Ireland, Italy, Latvia, Lithuania, Luxembourg, the Netherlands, Norway, Poland, Portugal, the Russian Federation, Slovakia, Spain, Sweden, Switzerland, Ukraine and the UK; and the USA.

PARTICIPANTS

National populations aged 18-100 years, by sex.

MEASUREMENTS

Using data by age and sex, we calculated obesity-attributable mortality by multiplying all-cause mortality (Human Mortality Database) with obesity-attributable mortality fractions (OAMFs). OAMFs were obtained by applying the weighted sum method to obesity prevalence data (non-communicable diseases (NCD) Risk Factor Collaboration) and European relative risks (Dynamic Modeling for Health Impact Assessment (DYNAMO- HIA)). We estimated potential gains in life expectancy (PGLE) at birth by eliminating obesity-attributable mortality from all-cause mortality using associated single-decrement life tables.

RESULTS

In the 26 European countries in 2012, PGLE due to obesity ranged from 0.86 to 1.67 years among men, and from 0.66 to 1.54 years among women. In all countries, PGLE increased over time, with an average annual increase of 2.68% among men and 1.33% among women. Among women in Denmark, Switzerland, and Central and Eastern European countries, the increase in PGLE levelled off after 1995. Without obesity, the average increase in life expectancy between 1975 and 2012 would have been 0.78 years higher among men and 0.30 years higher among women.

CONCLUSIONS

Obesity was proven to have an impact on both life expectancy levels and trends in Europe. The differences found in this impact between countries and the sexes can be linked to contextual factors, as well as to differences in people's ability and capacity to adopt healthier lifestyles.

It's better together! European perspective on benefits and challenges associated with cross-border health communication campaigns

Recent years have witnessed greater involvement of European Union (EU) organisations in health communication campaigns that address chronic diseases and that are designed for implementation in multiple countries. This development raises challenges inherent in adapting the design of public health communication campaigns to multi-national settings. This article provides a first exploratory investigation of these challenges and how to address them based on data gathered from four expert focus groups, each concentrated on a common risk factor for chronic disease: smoking, alcohol consumption, unhealthy diet and sedentary lifestyle. Despite the exploratory nature of the data, it was possible to identify several common key challenges: variation in behaviours, social and cultural norms, and issues related to language and communication channels, the divide between EU stakeholders and local actors, and differences in national legislation and available resources. Two risk factor-specific challenges were also identified: effective messaging for complex issues (unhealthy diet) and the involvement of industry representatives (smoking, sedentary lifestyle). We propose conceiving of cross-national communication campaigns as providing a common blueprint and structure that can inform and support the development of differentiated yet harmonised local campaigns.

Smoking, alcohol and cancer mortality in Eastern European men: Findings from the PrivMort retrospective cohort study

Eastern European men have among the highest cancer mortality rates globally. Prevalence of smoking and alcohol intake in this region is also high. The aim of our study was to calculate population attributable risk fraction (PARF) of cancer deaths from smoking and alcohol in Russia, Belarus and Hungary, and to examine the contribution of these lifestyle factors to differences in male cancer mortality in the three countries. Data were collected as part of the PrivMort retrospective cohort study. Randomly selected participants living in mid-size towns in Russia, Belarus and Hungary provided information on smoking habits, alcohol consumption, vital status and cause of death (if applicable) of male relatives (fathers, siblings and partners). PARF of cancer deaths (age 35-79) due to smoking, alcohol consumption and both combined was estimated between 2001 and 2013. Among 72,190 men, 4,702 died of cancer. Age standardized cancer mortality rates were similar to official data in all three countries. The estimated PARF (95% CI) associated with measures of smoking, alcohol consumption, both combined, and overall smoking or drinking were 25% (19-30), 2% (0-4), 29% (19-39), 43% (32-53) in Russia, 18% (8-28), 2% (-1 to 6), 28% (20-35), 38% (25-50) in Belarus and 17% (13-20), 1% (0-3), 25% (20-30), 35% (28-42) in Hungary, respectively. These results suggest that in Eastern Europe, at least one third of cancer deaths in males may have been attributable to smoking and/or alcohol consumption in recent years. Health policies targeting these lifestyle factors can have a major impact on population health.

Cancer Control in Central and Eastern Europe

In Central and Western Europe, cancer mortality is declining at slower rates as compared with rates in the rest of the world. More than a generation has now passed since the end of nonmarket economies in Central and Eastern Europe. It is time for this area of the continent to close the gap in cancer incidence and mortality rates between it and Western Europe and other high-income areas of the world.

Acute coronary syndromes in low- and middle-income countries: Moving forward

Cardiovascular disease remains the leading cause of death worldwide, particularly in low- and middle-income countries (LMICs), with substantial mortality from acute coronary syndromes. These deaths, when compared against high-income countries, occur at younger ages, and, beyond the lives lost, often result in economic privation for families deprived of a breadwinner and indebted by the oftentimes catastrophic cost of inpatient medical care. This burden will likely grow in scale in the years ahead as more countries pass through the epidemiologic transition. Billions around the world are beginning to experience the comforts that even modestly increased incomes can provide, including diets high in fats and sugars, more sedentary lifestyles, and tobacco and alcohol use and abuse. Health care systems in many of these countries are ill-equipped to prevent the harms caused by these lifestyles, as well as treat the acute coronary syndromes that result from them-including insufficient access to appropriate facilities and medications, difficulties with transport, and low awareness of the symptoms and need for emergent evaluation.

Alcohol Consumption in Russia and Some Aspects of Public Health

CONTEXT

The problem of alcohol misuse in Russia is immense; but nonetheless there is a tendency to exaggerate it, which is evident for inside observers. Such exaggeration tends to veil shortcomings of the health care system with responsibility shifted onto the patients, that is, self-inflicted diseases caused by excessive alcohol consumption. The aim of this report is to draw attention to the above-mentioned and other problems related to the alcohol consumption in Russia, not clearly perceptible from the literature, e.g. toxicity of some legally sold alcoholic beverages.

EVIDENCE ACQUISITION

This report is based on a review of literature and observations by the author during the period 1970 - 2014.

RESULTS

Predictable increase of alcohol consumption after the anti-alcohol campaign facilitated the economical reforms of the early 1990s: workers and some intelligentsia did not oppose privatizations of state-owned enterprises partly due to their drunkenness, involvement in workplace theft and use of equipment for profit, which was often tolerated by the management at that and earlier time.

CONCLUSIONS

Last time, a gradual change of the alcohol consumption pattern in Russia has been noticed: less heavy binge drinking of vodka, fortified wine and surrogates; more moderate consumption of beer.

Trends in colorectal cancer mortality in Europe: retrospective analysis of the WHO mortality database

OBJECTIVE

To examine changes in colorectal cancer mortality in 34 European countries between 1970 and 2011.

DESIGN

Retrospective trend analysis.

DATA SOURCE

World Health Organization mortality database.

POPULATION

Deaths from colorectal cancer between 1970 and 2011. Profound changes in screening and treatment efficiency took place after 1988; therefore, particular attention was paid to the evolution of colorectal cancer mortality in the subsequent period.

MAIN OUTCOMES MEASURES

Time trends in rates of colorectal cancer mortality, using joinpoint regression analysis. Rates were age adjusted using the standard European population.

RESULTS

From 1989 to 2011, colorectal cancer mortality increased by a median of 6.0% for men and decreased by a median of 14.7% for women in the 34 European countries. Reductions in colorectal cancer mortality of more than 25% in men and 30% in women occurred in Austria, Switzerland, Germany, the United Kingdom, Belgium, the Czech Republic, Luxembourg, and Ireland. By contrast, mortality rates fell by less than 17% in the Netherlands and Sweden for both sexes. Over the same period, smaller or no declines occurred in most central European countries. Substantial mortality increases occurred in Croatia, the former Yugoslav republic of Macedonia, and Romania for both sexes and in most eastern European countries for men. In countries with decreasing mortality, reductions were more important for women of all ages and men younger than 65 years. In the 27 European Union member states, colorectal cancer mortality fell by 13.0% in men and 27.0% in women, compared with corresponding reductions of 39.8% and 38.8% in the United States.

CONCLUSION

Over the past 40 years, there has been considerable disparity in the level of colorectal cancer mortality between European countries, as well as between men and women and age categories. Countries with the largest reductions in colorectal cancer mortality are characterised by better accessibility to screening services, especially endoscopic screening, and specialised care.

Some Aspects of Nonbeverage Alcohol Consumption in the Former Soviet Union

Toxicity of some legally sold alcoholic beverages has contributed to enhanced mortality in Russia since 1990. Widespread drunkenness during the early 1990s facilitated privatization of economy: workers and some intelligentsia did not oppose privatizations because of drunkenness and involvement in illegal activities. Apparently, alcohol consumption and heavy binge drinking have been decreasing in Russia since approximately the last decade. Exaggeration of alcohol-related problems tends to veil shortages of the health care system. There are motives to exaggerate consumption of nonbeverage alcohol in order to veil the problem of toxicity of some legally sold beverages. It is essential to distinguish between legally and illegally sold rather than between recorded and unrecorded alcohol because sales of poor-quality alcoholic beverages in legally operating shops and kiosks occurred generally with knowledge of authorities.

Tobacco control in Poland-successes and challenges

For many years, tobacco smoking was the major single avoidable cause of premature mortality in Poland. In the 1970s and 1980s, Poland was a country with an extremely high prevalence of smoking and lung cancer mortality among men in the world. By 1990, over 40% of Polish men died prematurely from smoking-attributed diseases. However, the enforcement of comprehensive tobacco-control measures and programs based on the World Health Organization recommendations and the best practices from other countries, contributed to a spectacular decrease of smoking incidence, particularly in men. This led to dramatic decrease in lung cancer incidence and mortality, and to a substantial improvement in public health in Poland. This article reviews the achievements of tobacco-control in Poland over the past decades and points out current challenges in this field.

Elder Abuse and Neglect Versus Parricide

Violence in families and elder abuse can take many forms, which his sometimes difficult to recognize. In Russia, elder abuse is rarely discussed in professional literature and mass media. A border between elder abuse and parricide can be indistinct. Borderline cases can include involvement of older people in binge drinking, denial of help, and manipulation towards suicide. Three example cases are discussed in this report. A concluding point is that for prevention of parricide, it should be kept devoid of its reputation as an extraordinary crime, committed mainly by mentally ill individuals. The perpetrators can be mentally healthy or have a personality disorder. Parricide can have trivial appearance, not always recognized as such by victims and social environment.

Worldwide patterns of ischemic heart disease mortality from 1980 to 2010

BACKGROUND

The trends in the IHD mortality rates vary widely across countries, reflecting the heterogeneity in the variation of the exposure to the main risk factors and in the access to different management strategies among settings. We aimed to identify model-based patterns in the time trends in IHD mortality in 50 countries from the five continents, between 1980 and 2010.

METHODS AND RESULTS

Mixed models were used to identify time trends in age-standardized mortality rates (ASMR) (age group 35+years; world standard population), all including random terms for intercept, slope, quadratic and cubic. Model-based clustering was used to identify the patterns. We identified five main patterns of IHD mortality trends in the last three decades, similar for men and women. Pattern 1 had the highest ASMR and pattern 2 exhibited the most pronounced decrease in ASMR during the entire study period. Pattern 3 was characterized by an initial increase in ASMR, followed by a sharp decline. Countries in pattern 4 had the lowest ASMR throughout the study period. It was further divided into patterns 4a (consistent decrease in ASMR throughout the period of analysis) and 4b (less pronounced declines and highest rates observed mostly between 1996 and 2004). There was no correspondence between the geographic or economical grouping of the analyzed countries and the patterns found in this study.

CONCLUSIONS

Our study yielded a new framework for the description, interpretation and prediction of IHD mortality trends worldwide.

A comparison of trends in caesarean section rates in former communist (transition) countries and other European countries

Caesarean section rates are rising across Europe, and concerns exist that increases are not clinically indicated. Societal, cultural and health system factors have been identified as influential. Former communist (transition) countries have experienced radical changes in these potential determinants, and we, therefore, hypothesized they may exhibit differing trends to non-transition countries. By analysing data from the WHO Europe Health for All Database, we find transition countries had a relatively low caesarean section rate in 2000 but have since experienced more rapid increases than other countries (average annual percentage change 7.9 vs. 2.4).

[Limited access to the international medical literature in Russia]

Limited access to foreign professional literature in the former Soviet Union had consequences for public health: persistence of some outdated methods and approaches. Several examples are discussed in this letter. The shortage of foreign literature has been partly compensated by domestic editions, sometimes containing compilations from foreign sources, borrowings without references, and mistranslations. International literature is on average scarcely quoted in Russian language scientific publications. Today, however, there are grounds for optimism: the economic upturn must bring improvements.

World Congress of Epidemiology 2011: themes and highlights

Modern-day epidemiologists are confronted with huge changes, such as the rise in the global population due to reduced mortality, migration within and across countries, massive shifts in economic standing and lifestyles, and environmental degradation. With over 1000 posters, more than 100 oral presentations, 16 workshops, four lunchtime symposia, many exhibitions and immeasurable discussions, the task of capturing all highlights of the International Epidemiology Association (IEA) World Congress of Epidemiology 2011 is impossible, but this article has provided a sample. Many presenters showed that the challenges facing global health are complex, changing and in demand of measurement, and they demonstrated the central role of epidemiology. The cutting-edge methodologies theme promised the emergence of a more transparent, better balanced, but also more critical approach to dealing with bias. Preceding the United Nations high-level meeting on non-communicable diseases (New York, 19th-20th September 2011), the Congress's chronic diseases stream was especially timely. The neglected conditions theme illustrated inspiring work battling against apathy, inertia and ignorance; perhaps the special challenge of the 'neglected conditions epidemiologist'. Translating epidemiology's insights into effective policies and programmes to prevent diseases or reduce their impact is not easy. Speakers highlighted the common failure of epidemiologists to contribute actively to improving the health of the populations they serve, especially the poor and disadvantaged, but also provided many examples where they had done so. The 'other' theme ensured that important studies were not lost from the programme just because they did not fit easily into the specific themes. The studies focused on identified risk factors throughout the life course. A variety of methods were used to identify factors that altered the rate of birth, disease and death. Ongoing epidemiology is not only broad but is also deep, and ever more so as collaborative pooling of expertise, data, populations and ideas has emerged, accelerated by modern-day communication technologies. Epidemiology, and epidemiologists, seem poised for tomorrow's world.