Age-period-cohort effect on lung cancer mortality in Spain, 1982-2021

BACKGROUND

The aim of the study is to provide up-to-date information and evaluate the age-period-cohort effects of age-period cohorts on lung cancer (LC) mortality in Spain for the period 1982 to 2021.

METHODS

We analysed deaths by LC and population for the period 1982-2021, available from the Spanish National Institute of Statistics. The LC corresponds to code 162 and codes C33 and C34 of the 9th and 10th editions of the International Classification of Diseases, respectively. Age-period-cohort (A-P-C) modelling was applied to compute the net drift, local drift, longitudinal age curve, and rate ratios (RR) of each period and cohort. A-P-C analysis was performed using the A-P-C Web Tool provided by the National Cancer Institute of the United States.

RESULTS

Estimated relative risk in the male birth cohorts has followed a steady downward trend in all cohorts born since 1922, showing an initial period (1922-1947) of slight decline, followed by a more marked decrease in the cohorts born during the period 1947-1977. In the younger cohorts (1977-1997), the decline appears to have stabilised. In women, a strong cohort effect is observed. In those born after the Spanish Civil War (1936 to 1939), the risk increased until it peaked in the 1960s, after which it started to decrease with the same intensity. Period RR in men decreased from 1987 to 1991 (1.1) to 2017-2021 (0.6), while period RR in women increased during this time (from 0.8 to 1.6).

CONCLUSIONS

The cohort effect observed in women born after the Civil War suggests that the onset of the LC epidemic may have been due to a higher prevalence of women smokers in these cohorts. However, the trend observed in the younger cohorts suggests a possible slowing-down in the increase in mortality risk in the following years.

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.

Trends in socioeconomic inequalities in preventable mortality in urban areas of 33 Spanish cities, 1996-2007 (MEDEA project)

Background

Preventable mortality is a good indicator of possible problems to be investigated in the primary prevention chain, making it also a useful tool with which to evaluate health policies particularly public health policies. This study describes inequalities in preventable avoidable mortality in relation to socioeconomic status in small urban areas of thirty three Spanish cities, and analyses their evolution over the course of the periods 1996–2001 and 2002–2007.

Methods

We analysed census tracts and all deaths occurring in the population residing in these cities from 1996 to 2007 were taken into account. The causes included in the study were lung cancer, cirrhosis, AIDS/HIV, motor vehicle traffic accidents injuries, suicide and homicide. The census tracts were classified into three groups, according their socioeconomic level. To analyse inequalities in mortality risks between the highest and lowest socioeconomic levels and over different periods, for each city and separating by sex, Poisson regression were used.

Results

Preventable avoidable mortality made a significant contribution to general mortality (around 7.5%, higher among men), having decreased over time in men (12.7 in 1996–2001 and 10.9 in 2002–2007), though not so clearly among women (3.3% in 1996–2001 and 2.9% in 2002–2007). It has been observed in men that the risks of death are higher in areas of greater deprivation, and that these excesses have not modified over time. The result in women is different and differences in mortality risks by socioeconomic level could not be established in many cities.

Conclusions

Preventable mortality decreased between the 1996–2001 and 2002–2007 periods, more markedly in men than in women. There were socioeconomic inequalities in mortality in most cities analysed, associating a higher risk of death with higher levels of deprivation. Inequalities have remained over the two periods analysed. This study makes it possible to identify those areas where excess preventable mortality was associated with more deprived zones. It is in these deprived zones where actions to reduce and monitor health inequalities should be put into place. Primary healthcare may play an important role in this process.

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).

Cost-effectiveness analysis of pemetrexed versus docetaxel in the second-line treatment of non-small cell lung cancer in Spain: results for the non-squamous histology population

Background

The objective of this study was to conduct a cost-effectiveness evaluation of pemetrexed compared to docetaxel in the treatment of advanced or metastatic non-small cell lung cancer (NSCLC) for patients with predominantly non-squamous histology in the Spanish healthcare setting.

Methods

A Markov model was designed consisting of stable, responsive, progressive disease and death states. Patients could also experience adverse events as long as they received chemotherapy. Clinical inputs were based on an analysis of a phase III clinical trial that identified a statistically significant improvement in overall survival for non-squamous patients treated with pemetrexed compared with docetaxel. Costs were collected from the Spanish healthcare perspective.

Results

Outcomes of the model included total costs, total quality-adjusted life years (QALYs), total life years gained (LYG) and total progression-free survival (PFS). Mean survival was 1.03 years for the pemetrexed arm and 0.89 years in the docetaxel arm; QALYs were 0.52 compared to 0.42. Per-patient lifetime costs were € 34677 and € 32343, respectively. Incremental cost-effectiveness ratios were € 23967 per QALY gained and € 17225 per LYG.

Conclusions

Pemetrexed as a second-line treatment option for patients with a predominantly non-squamous histology in NSCLC is a cost-effective alternative to docetaxel according to the € 30000/QALY threshold commonly accepted in Spain.

[Incidence of bronchopulmonary cancer in Castilla y Leon and Cantabria in the year 2007. A study by the Castilla y Leon and Cantabria Respiratory Diseases Society (SOCALPAR)]

INTRODUCTION

This study sets out to find out the incidence and other epidemiological characteristics of bronchopulmonary cancer in patients living in Cantabria and Castilla y Leon (Spain) and comparing the current data obtained in the last communities with that obtained 10 years ago in a similar study.

PATIENTS AND METHODS

Prospective, multicentre study using information (age, sex, residence, smoking habits and histology) obtained from all patients diagnosed during the year 2007.

RESULTS

A total of 1486 patients were included--1295 males (87.1%) and 191 females (12.9%)--, of whom 1145 lived in Castilla y Leon--1010 males (88.2%) and 135 females (11.8%)--, and 341 in Cantabria--285 males (83.6%) and 56 females (16.4%)--. The incidence rates per 100,000 inhabitants adjusted to the world standard population were significantly higher in Cantabria [29.53; (males: 52.9; females: 9.76)] than in Castilla y Leon [21.35; (males: 38.31; females: 5.58)]. A total of 90.24% were smokers (males: 96.12% and women: 49.17%). The main histology types were: squamous, 32, 82%; adenocarcinoma, 28.74%, and small cell carcinomas, 18.33%. In Castilla y Leon, from 1997 to 2007, the numbers went from 920 to 1010 in males and from 95 to 135 in females (a crude rate increase of 10.5% in males and 43% in females), and showed a decrease in squamous tumours and an increase in adenocarcinomas.

CONCLUSIONS

The incidence rates of bronchopulmonary cancer in 2007 were significantly higher in Cantabria than those of Castilla y Leon. The 2007 rates in this community were higher than in 1997 in both males and females.

Bronchogenic carcinoma in patients under 50 years old

INTRODUCTION

Lung cancer in young patients is increasing in frequency. Its clinical course seems to be more aggressive than in the elderly. Our objective is to assess the clinicopathologic characteristics and survival of patients with bronchogenic carcinoma who underwent surgery at our department, comparing people younger than 50 years to older patients.

MATERIALS AND METHODS

We present a retrospective study of 610 patients diagnosed with non-small-cell lung cancer operated on between 1997 and 2006. They were classified into two groups: under 50 (n=60) and equal to or over 50 (n=550).

RESULTS

The proportion of women, smokers and adenocarcinoma were significantly higher in young patients. There were no significant differences in survival rate between the two groups.

CONCLUSIONS

In our series, despite the differences in sex, smoking history and histology, the behaviour of the disease is similar in both age groups.