Time trend and age-period-cohort effect on kidney cancer mortality in Europe, 1981-2000

Time trend and age-period-cohort effect on kidney cancer mortality in Spain, 1983-2022

OBJECTIVE

This study examines trends and disparities in kidney cancer (KC) mortality in Spain from 1983 to 2022, focusing on gender, birth cohort, and age influences.

METHODS

Data from the Spanish National Institute of Statistics were analyzed using age-standardized mortality rates (ASMRs). Joinpoint regression identified temporal trends and annual percentage changes, while Age-Period-Cohort (A-P-C) analysis assessed the impacts of age, calendar period, and birth cohort on mortality.

RESULTS

KC mortality increased significantly for both sexes, with men experiencing a steeper rise (1.2% annually) compared to women (0.6% annually). Joinpoint analysis revealed distinct phases: a sharp increase until the mid-1990s, followed by stabilization for men and a slight decline for women. Men aged over 50, particularly those above 80, showed pronounced increases. A-P-C analysis confirmed age as a significant risk factor, with consistently higher mortality rates observed among men across all age groups. Men born from the early 20th century until the 1960s faced increasing mortality risks, while women's risk, after an increase in the early 20th century, stabilized after the 1933 birth cohort. For those born after 1960, both sexes show a potential decline in KC mortality, with a slight upturn in men from the 1980s onwards. The period effect exhibited an increase during the 1980s-1990s, followed by stabilization for men and a continuous decrease for women.

CONCLUSION

This study reveals significant disparities in KC mortality trends in Spain across genders, birth cohorts, and age groups. Despite advancements in diagnosis and treatment, substantial public health challenges remain.

The influence of age, period, and cohort factors on the incidence of kidney cancer in Spain 1990-2019: Evidence from the global burden of disease study

OBJECTIVE

This study aimed to assess the influence of age, period, and cohort (A-P-C) factors on kidney cancer (KC) incidence trends in Spain from 1990 to 2019.

METHODS

Employing data from the Global Burden of Disease Study 2019, we employed joinpoint analysis to determine long-term patterns and A-P-C modelling to quantify net drift, local drift, longitudinal age curves, and rate ratios (RRs) of period and cohort effects.

RESULTS

Over the period 1990-2019, an estimated 142,811 cases of KC were diagnosed in Spain. A consistent upward trend in KC incidence was observed for both men and women, with the male-to-female ratio remaining stable at 2.6. Joinpoint analysis identified three distinct periods for men: An initial period (1990-1995) characterised by a significant increase in rates, a subsequent period (1995-2016) characterised by a slowdown in the rate of increase, and a final period (2016-2019) in which rates have plateaued. In women, 2 time periods were observed: an initial period (1990-2007) in which rates increased significantly, followed by a period of stabilization (2007-2019). Men born in the early-mid 20th century had a rising KC risk, peaking in the 1960s. Women's risk rose steadily, peaking in the late 1990s.

CONCLUSION

A-P-C analysis reveals steady KC incidence increase in both genders over three decades. This highlights the need for targeted public health policies and effective prevention strategies.

Mortality Trends from Urologic Cancers in Europe over the Period 1980-2017 and a Projection to 2025

BACKGROUND

Patterns and trends in urologic cancer mortality still show geographical differences across Europe.

OBJECTIVE

To monitor mortality trends from urologic cancers, including prostate, testis, bladder, and kidney cancers, in Europe.

DESIGN, SETTING, AND PARTICIPANTS

We carried out a time-trend analysis for 36 European countries using the official World Health Organization database.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

We extracted the number of deaths and population data over the 1980-2017 period, and calculated age-standardised (world population) mortality rates for each cancer considered, sex, country, and the European Union (EU) as a whole, at all ages; at ages 35-64 yr for prostate, bladder, and kidney cancers; and at ages 20-44 yr for testicular cancer. For selected major countries, we carried out a joinpoint regression analysis to identify significant changes in trends. We also predicted the number of deaths and rates for 2025, using a logarithmic Poisson count data joinpoint regression model.

RESULTS AND LIMITATIONS

Prostate cancer mortality in the EU decreased over recent years, reaching a rate of 10.3/100 000 in 2015 and a projected rate of 8.9/100 000 in 2025. Less favourable trends were observed in eastern Europe, though starting from relatively low rates. Testicular cancer mortality declined over time in most countries, however levelling off in northern and western countries, after reaching very low rates. EU testicular cancer mortality rate in 2015 was 0.3/100 000 at all ages and 0.6/100 000 at ages 20-44 yr. Bladder cancer mortality trends were less favourable in central and eastern countries compared to northern and western ones. The EU rates in 2015 were 5.1/100 000 men and 1.1/100 000 women. Kidney cancer mortality showed less favourable trends, with a slight increase in men and stable rates in women over the past decade in the EU.

CONCLUSIONS

Mortality from prostate, testis, and bladder cancers, but not from kidney cancer, declined in most European countries, with less favourable trends in most eastern countries.

PATIENT SUMMARY

Over the past four decades, mortality from prostate, testis, and bladder cancers, but not from kidney cancer, declined in most European countries. Prostate cancer mortality rates remain lower in Mediterranean countries than in northern and central Europe. Rates for all urologic cancers remain higher in central and eastern Europe.

Incidence and mortality of kidney cancer: temporal patterns and global trends in 39 countries

We tested the hypotheses that kidney cancer incidence was increasing globally whilst its mortality was reducing; and its incidence was positively correlated with country-specific socioeconomic development. The incidence and mortality figures of each country were projected to 2030. Data on age-standardized incidence/mortality rates were retrieved from the GLOBOCAN in 2012. Temporal patterns were examined for 39 countries from the Cancer Incidence in Five Continents volumes I-X and other national registries. We evaluated the correlation between the incidence/mortality rates and Human Development Index (HDI)/Gross Domestic Product (GDP]). The average annual percent change of its incidence and mortality in the most recent 10 years was obtained from joinpoint regression. The highest incidence rates were observed in Eastern Europe and North America, while its mortality rates were the highest in European countries. Incidence was positively correlated with HDI and GDP per capita. Many countries experienced incidence rise over the most recent 10 years, and a substantial reduction in mortality rates was observed for a significant number of countries, yet increases in mortality rates were observed in Eastern Europe. By 2030, Brazil and Ecuador may have the greatest rise in incidence both in men and women, which requires urgent need for planning healthcare resources.

The development and experience of epidemiological transition theory over four decades: a systematic review

BACKGROUND

Epidemiological transition (ET) theory, first postulated in 1971, has developed alongside changes in population structures over time. However, understandings of mortality transitions and associated epidemiological changes remain poorly defined for public health practitioners. Here, we review the concept and development of ET theory, contextualising this in empirical evidence, which variously supports and contradicts the original theoretical propositions.

DESIGN

A Medline literature search covering publications over four decades, from 1971 to 2013, was conducted. Studies were included if they assessed human populations, were original articles, focused on mortality and health or demographic or ET and were in English. The reference lists of the selected articles were checked for additional sources.

RESULTS

We found that there were changes in emphasis in the research field over the four decades. There was an increasing tendency to study wide-ranging aspects of the determinants of mortality, including risk factors, lifestyle changes, socio-economics, and macro factors such as climate change. Research on ET has focused increasingly on low- and middle-income countries rather than industrialised countries, despite its origins in industrialised countries. Countries have experienced different levels of progress in ET in terms of time, pace, and underlying mechanisms. Elements of ET are described for many countries, but observed transitions have not always followed pathways described in the original theory.

CONCLUSIONS

The classic ET theory largely neglected the critical role of social determinants, being largely a theoretical generalisation of mortality experience in some countries. This review shows increasing interest in ET all over the world but only partial concordance between established theory and empirical evidence. Empirical evidence suggests that some unconsidered aspects of social determinants contributed to deviations from classic theoretical pathways. A better-constructed, revised ET theory, with a stronger basis in evidence, is needed.

Body mass index and risk of renal cell cancer: a dose-response meta-analysis of published cohort studies

Obesity is accepted as one of the major risk factors for renal cell cancer (RCC). However, conflicting results persist for the pooled risks based on the results from case-control and cohort studies combined, and the exact shape of the dose-response relationship has not been clearly defined yet. To help elucidate the role of obesity, PubMed and Embase databases were searched for published cohort studies on associations between body mass index (BMI) and risk of RCC. Random-effects models and dose-response meta-analyses were used to pool study results. Subgroup analyses were conducted by the available characteristics of studies and participants. Cohort studies (21) with 15,144 cases and 9,080,052 participants were identified. Compared to normal weight, the pooled relative risks and the corresponding 95% confidence intervals of RCC were 1.28(1.24-1.33) for preobesity and 1.77(1.68-1.87) for obesity, respectively. A nonlinear dose-response relationship was also found for RCC risk with BMI (p = 0.000), and the risk increased by 4% for each 1 kg/m(2) increment in BMI. There was no significant between-study heterogeneity among studies (I(2) = 35.6% for preobesity and I(2) = 44.2% for obesity, respectively). Subgroup analysis showed a basically consistent result with the overall analysis. These results suggest that increased BMI are associated with increased risk of RCC both for men and women.

Modest improvement in 20 years of kidney cancer care in the Netherlands

AIM

For an evaluation of the progress achieved in the field of kidney cancer care in the Netherlands in the last decades, we described trends in incidence, treatment, mortality and relative survival.

METHODS

All adult patients newly diagnosed with kidney cancer between 1989 and 2009 (N=32,545) were selected from the Netherlands Cancer Registry. Age-standardised incidence and mortality rates were calculated. Follow-up was completed until January 2010. In order to assess trends estimated annual percentages of change (EAPC) were estimated.

RESULTS

The incidence of kidney cancer has been fairly stable between 1989 and 2001 with a European Standardised Rate of approximately 11 per 100,000 person years (PY). Since 2001 the incidence increased to 13 per 100,000 PY in 2009 (EAPC: 2.4%; 95%confidence interval (CI): 1.5 to 3.4%). The mortality rate decreased slightly over time, from 6.2 per 100,000 PY in 1989 to 5.6 in 2010. No changes in treatment were observed, except for the introduction of targeted therapies for stage IV disease, since 2005. The 5-year relative survival improved from 51% in 1989-1994 to 58% in 2005-2009 (EAPC: 0.9%; 95%CI 0.7 to 1.2%). Improvement in survival was especially seen in males, younger age groups and low stages.

CONCLUSIONS

The incidence of kidney cancer has increased slightly, and survival improved modestly, resulting in a decreasing mortality. A positive effect of the introduction of targeted therapies for metastatic kidney cancer was observed in 1-year relative survival. For progress in kidney cancer care, effective prevention strategies and new therapies remain warranted.

Risks and benefits of dietary isoflavones for cancer

A high intake of fruits and vegetables is associated with a lower risk of cancer. In this context, considerable attention is paid to Asian populations who consume high amounts of soy and soy-derived isoflavones, and have a lower risk for several cancer types such as breast and prostate cancers than populations in Western countries. Hence, interest focuses on soyfoods, soy products, and soy ingredients such as isoflavones with regard to their possible beneficial effects that were observed in numerous experiments and studies. The outcomes of the studies are not always conclusive, are often contradictory depending on the experimental conditions, and are, therefore, difficult to interpret. Isoflavone research revealed not only beneficial but also adverse effects, for instance, on the reproductive system. This is also the case with tumor-promoting effects on, for example, breast tissue. Isoflavone extracts and supplements are often used for the treatment of menopausal symptoms and for the prevention of age-associated conditions such as cardiovascular diseases and osteoporosis in postmenopausal women. In relation to this, questions about the effectiveness and safety of isoflavones have to be clarified. Moreover, there are concerns about the maternal consumption of isoflavones due to the development of leukemia in infants. In contrast, men may benefit from the intake of isoflavones with regard to reducing the risk of prostate cancer. Therefore, this review examines the risks but also the benefits of isoflavones with regard to various kinds of cancer, which can be derived from animal and human studies as well as from in vitro experiments.

Fish, vitamin D, and flavonoids in relation to renal cell cancer among smokers

Fish, vitamin D, flavonoids, and flavonoid-containing foods may have cardiovascular benefits and therefore may also reduce the risk of renal cell cancer. Risk was prospectively assessed in the Alpha-Tocopherol Beta-Carotene Cancer Prevention Study (1985-2002) cohort (N = 27,111; 15.2 mean person-years of follow-up). At enrollment, demographic, health, and dietary history information was recorded. Individuals who smoked less than 5 cigarettes/day, with chronic renal insufficiency or prior cancer, were excluded. Hazard ratios and 95% confidence intervals from Cox regression were used to compare upper quartiles (quartiles 2-4) with the lowest quartile (quartile 1) of dietary intake. Among 228 cases, risk (quartile 4 vs. quartile 1) was associated with consumption of the flavonoid quercetin (hazard ratio = 0.6, 95% confidence interval: 0.4, 0.9; P(trend) = 0.015) and Baltic herring (hazard ratio = 2.0, 95% confidence interval: 1.4, 3.0; P(trend) < 0.001), with adjustment for age, body mass index, smoking, blood pressure, alcohol use, physical activity, urban residence, and education. In geographically stratified models, the risks associated with herring and total fish intake appeared to be highest in the urban coast region, although the interaction was not statistically significant. These results suggest that the flavonoid quercetin may prevent renal cell cancer among male smokers. The possible risk associated with fish intake warrants further investigation before conclusions may be drawn.