Patrón evolutivo de la incidencia de cáncer de tiroides en la Región de Murcia de 1984 a 2008

Objective

To study the trend pattern of the incidence of thyroid cancer.

Methods

We selected incident cases of thyroid cancer occurring in the Region of Murcia (Spain) in 1984-2008. The variables gathered were age, sex, date of diagnosis, and morphology. We calculated incidence rates and the annual percentage of change using Bayesian age-period-cohort models.

Results

During the study period, 1414 cases were diagnosed, representing an increase in adjusted rates from 2.9/100000 in 1984-1988 to 7.3 in 2004-2008. The incidence was 3.5 times higher in women than in men and the most frequent morphology was papillary carcinoma (67.7%). An increasing trend was found in both genders; these increments were more pronounced in papillary carcinoma. In women, the incidence increased with age, calendar year, and in those born in 1945-1963. The incidence of papillary microcarcinoma increased four-fold in women.

Conclusions

Thyroid cancer used to be a rare cancer but has become an emerging tumor. The greatest changes were found in papillary thyroid cancer, including a gradual increase in the proportion of microcarcinoma.     

Evolución de las desigualdades sociales en la mortalidad general de la ciudad de Cádiz (1992–2007)

Objective

To analyze trends in socioeconomic inequality in mortality in the city of Cadiz (Spain) from 1992 to 2007.

Methods

An ecological study was performed of trends over 3 cross-sections, with the census tract as the unit of analysis. Deaths were grouped into three periods: 1992-1996, 1997-2001 and 2002-2007 and were then classified according to a deprivation index of the census tract. We calculated adjusted rates by the direct method and three measures of health inequality.

Results

Of 18,586 deaths, 96.7% was geocoded to a census tract. The population-attributable risk decreased in men and women, respectively, from 15.4% and 12.2% in 1992-1996 to 9.3% and 5.6% in 2002-2007. The other measures, slope index and the relative index also showed a decline in inequality but only among women.

Conclusions

Despite a decreasing trend, social inequalities are a substantial component in the distribution of overall mortality in the city of Cadiz.     

Estudio de la evolución de la exposición a plomo en la población infantil española en los últimos 20 años. ¿Un ejemplo no reconocido de «salud en todas las políticas»?

Objective

To describe the time trend in atmospheric lead concentrations in Spain, from before lead was banned as a gasoline additive to the present, and to determine the trend in lead body burden in the Spanish child population.

Methods

We obtained the annual average for atmospheric lead levels in several Spanish cities from the 1980s to the present. A literature search was conducted to identify published studies on lead concentrations in populations of Spanish children.

Results

Overall, atmospheric lead levels decreased, particularly between 1991 and 1999. This downward trend was related to a decrease in lead concentrations in Spanish children from 1989, the year in which the first study of childhood lead exposure was published, until the present. The decreased concentrations in both air and in children was most probably a result of legislative measures regulating the maximum amount of lead in gasoline in 1987 until a complete ban in August 2001.

Conclusions

From a public health point of view, the banning of leaded gasoline has significantly increased health protection in the Spanish population.     

Incidence of colorectal cancer and influence of dietary habits in fifteen European countries from 1971 to 2002

Objective

This study aimed to analyze the incidence of colorectal cancer in 15 European countries in recent decades and the relationship between the incidence found and changes in dietary habits.

Methods

Pearson's or Spearman's correlation coefficients were calculated by comparing incidence rates obtained from the International Agency for Research on Cancer for 1971-2002 with data on per capita consumption obtained from the Food and Agriculture Organization of the United Nations using 10-year delay intervals.

Results

Incidence rates increased in all countries except France in men and except Austria, Denmark, England and France in women. Of the dietary variables considered, there were marked increasing trends (linear regression coefficient, R ≥0.5) in red meat consumption in Germany (R = 0.9), Austria (R = 0.7), Finland (R = 0.8), Italy (R = 0.9), Poland (R = 0.5), Spain (R = 2.1), Sweden (R = 0.6), and the Netherlands (R = 0.7).

Conclusions

Changes in dietary habits may be consistent with the observed trends in the incidence of colorectal cancer in the distinct European countries.     

The changing epidemiology of hepatitis A in Arizona following intensive immunization programs (1988-2007)

Introduction

Arizona had the highest hepatitis A incidence of any U.S. state during 1987–1997. In 1995, the first hepatitis A vaccines became available in the U.S. A series of hepatitis A vaccination policies and recommendations were implemented in 1996–2006. Our objective was to examine the shifting epidemiologic patterns in hepatitis A in Arizona from 1988 to 2007.

Methods

Passive surveillance reports to the Arizona Department of Health Services were used to compare hepatitis A rates by age, race/ethnicity and geographic area, before and after widespread vaccination. Reported risk factors and possible sources of infection were compared for two time periods. Age-adjusted incidence during three periods was mapped.

Results

Overall hepatitis A incidence in Arizona fell from 58 cases per 100,000 in 1988 to 2 per 100,000 in 2007. The proportion of reported cases among children dropped from 62% in 1994–1995 to 32% in 2006–2007. Racial/ethnic disparities between American Indians and non-Hispanic White populations have been eliminated. The geographic distribution of cases within the state has shifted. Earlier cases were likely to report contact with another hepatitis A case or childcare facilities, while later cases indicated recent international travel.

Conclusion

A major shift in the overall burden of hepatitis A and hepatitis A transmission has occurred in Arizona since the widespread implementation of immunization policies and the concomitant rise in vaccination rates in the state. Current transmission has shifted to older age groups and disparities by race/ethnicity are now highest in Hispanic populations. Future strategies to further reduce hepatitis A transmission may require broadening recommendations to include general adult populations without previous vaccination history.     

Incidence of acute hepatitis B in different ethnic groups in a low-endemic country, 1992-2009: Increased risk in second generation migrants

Background

The Netherlands is a low-incidence country for acute hepatitis B (HBV) infection (1.2/100,000 in 2010), where it is typically acquired in adulthood through injecting drug use or homosexual exposure. Recently, the number of heterosexually acquired acute infections in the Netherlands has increased. Ethnicity may be a risk factor. We describe trends in the incidence of acute HBV among heterosexual adults in ethnic groups in Amsterdam from 1992 to 2009 and discuss future control of HBV in the Netherlands.

Methods

We studied all cases of acute HBV acquired in heterosexuals aged ≥15 years in the Amsterdam region (1992–2009, n = 238) by ethnic group. Incidence rates were estimated as the average number of cases per 100,000 per year. Using Poisson regression, we calculated univariable and multivariable incidence rate ratios (IRR) by ethnic group over calendar year, by age and gender.

Results

The incidence in first generation migrants from HBV-endemic countries (FGM) was 4.1/100,000 showing no trend over time. Since 1999, incidence in Dutch-born cases in Amsterdam has increased by 13% annually from 0.2/100,000 in 1999 to 2.1/100,000 in 2009 (annual IRR 1.13, 95% CI:1.0–1.22). From 2004 to 2009, the incidence in native Dutch/Western in Amsterdam was 1.6/100,000 (reference for IRR), in FGM was 4.3/100,000 (IRR of 2.7, 95% CI:1.8–4.2) and in Dutch-born second generation migrants (SGM) was 3.7/100,000 (IRR:2.4, 95% CI:1.2–4.7).

Conclusion

Incidence of acute hepatitis B in Amsterdam in FGM and SGM is higher than in the native Dutch population. Low-endemic countries with migrant populations from HBV-endemic areas should consider offering screening and vaccination to both FGM and SGM.     

Comparing trends in mortality from cardiovascular disease and cancer in the United Kingdom, 1983–2013: joinpoint regression analysis

Background

We aimed to study the time trends underlying a change from cardiovascular disease (CVD) to cancer as the most common cause of age-standardized mortality in the UK between 1983 and 2013.

Methods

A retrospective trend analysis of the World Health Organization mortality database for mortality from all cancers, all CVDs, and their three most common types, by sex and age. Age-standardized mortality rates were adjusted to the 2013 European Standard Population and analyzed using joinpoint regression analysis for annual percent changes.

Results

The difference in mortality rate between total CVD and cancer narrowed over the study period as age-standardized mortality from CVD decreased more steeply than cancer in both sexes. We observed higher overall rates for both diseases in men compared to women, with high mortality rates from ischemic heart disease and lung cancer in men. Joinpoint regression analysis indicated that trends of decreasing rates of CVD have increased over time while decreasing trends in cancer mortality rates have slowed down since the 1990s. The lowest improvements in mortality rates were for cancer in those over 75 years of age and lung cancer in women.

Conclusions

In 2011, the age-standardized mortality rate for cancer exceeded that of CVD in both sexes in the UK. These changing trends in mortality may support evidence for changes in policy and resource allocation in the UK.

     

Use of a Population-Based Cancer Registry to Calculate Twenty-Year Trends in Cancer Incidence and Mortality in Fukui Prefecture

Background

There have been only a limited number of trend analyses of incidence and mortality using population-based cancer registry data in Japan, and the national statistics regarding incidence are estimated data. In the present study, data from the Fukui Prefecture cancer registry, which is the most accurate in Japan, were used to observe trends in incidence and mortality rates.

Methods

Cancer incidence and mortality rates from 1984 through 2004 were obtained from the Fukui Prefecture cancer registry. Joinpoint analysis developed for the US National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program was used to compute and graphically present annual percentage changes in age-adjusted incidence and mortality in Fukui Prefecture.

Results

On joinpoint analysis, there were slight increases in incidence at all cancer sites combined for both sexes from 1986, but the trend was not significant in Fukui. Mortality in women appeared to significantly decrease, while mortality in men, which had been increasing until 1999, began to significantly decrease thereafter. In an analysis by anatomical site, both the incidence and mortality of stomach cancer significantly decreased in both sexes. However, the incidence and mortality of breast and prostate cancers significantly increased. The mortality of liver and lung cancers also increased in both sexes.

Conclusions

Cancer mortality has been declining in recent years, and the reduction in mortality from stomach cancer has significantly affected the trends in Fukui. Urgent cancer control planning by the Fukui local government is necessary, especially for cancers of the liver, lung, prostate, and breast.Key words: incidence, mortality, population-based cancer registry     

Distribución municipal de la incidencia de los tumores más frecuentes en un área de elevada mortalidad por cáncer

Objective

To describe the geographic distribution patterns of the municipal incidence of the most common tumours in the Huelva province (Spain) as compared to the estimated incidence for all of Spain.

Health and economic impact of the seasonal influenza vaccination programme in England

Background

The seasonal influenza vaccination programme in England targets individuals over 65 years old and in clinical risk groups.

Methods

A model of influenza transmission and disease was fitted to weekly primary care consultations due to influenza in a typical pre-pandemic season (2006/2007). Different scenarios were constructed about influenza severity and how well vaccines match circulating strains to assess the impact and cost-effectiveness of the current vaccination programme.

Results

A well-matched vaccine may reduce the incidence of laboratory-confirmed influenza illness from 8.2% (95% range 4.3–13%) to 5.9% (95% range 2.9–9.7%), with 56–73% of this due to indirect protection. The programme is likely to be cost-effective unless both low severity and poor matching is assumed.

Conclusion

The current seasonal influenza vaccination programme appears to substantially reduce disease burden and provides good value for money.     

Surveillance of elevated blood lead levels in children in Torreon, Coahuila, Mexico, 1998-2010

Introduction

Because children exposed to lead have a very high health risk, surveillance and prevention programs are very important to avoid short- and long-term health effects.

Objectives

To describe the trend for the blood lead levels over a 12-year period in environmentally exposed children and to document the actions implemented to reduce the blood lead levels.

Materials and methods

We performed a retrospective cohort study of children aged 0–15 years who were enrolled in the Coahuila Health Secretary's Childhood Blood Lead Level Surveillance program. This database includes children from the city of Torreon, Coahuila, Mexico, where the biggest smelter in Latin America is located.

Results

A total of 151,322 observations were analyzed in the study. The percentage of samples with elevated blood lead levels decreased from 84.9% to 10.4% during 1998–2010, and the decrease was greater in girls than in boys.

Conclusion

According to the results of our study, the majority of strategies and activities to decrease blood lead levels in an environmentally exposed population should be focused on children aged 0–5 years, on the home environment, on preventing fugitive emissions from smelters and other sources and on the proper disposal and confinement of industrial residues.     

Seroprevalence of measles among children affected by national measles elimination program in Korea, 2010

Background

Following the implementation of national measles elimination plan in Korea, the elimination was declared in 2006. In order to sustain the elimination, high population immunity should be continuously monitored. To evaluate the current age-related susceptibility within the Korean population, we conducted the seroprevalence in children and adolescents who were affected by the national measles elimination plan.

Methods

We used residual serum specimens to measure measles specific IgG and geometric mean titer (GMT) in birth cohorts 2007–2008 and 1997–2003. Among birth cohorts, 2007–2008 cohorts were grouped to evaluate the timeliness of first dose of MMR, 1994–2003 cohorts were grouped to evaluate the effect of keep-up MMR2 campaign, and 1992–1993 cohorts were grouped to evaluate the effect of catch-up campaign in 2001.

Results

Overall, measles seropositivity rate was 86%. The highest seroprevalence of measles IgG was in birth cohorts 2007–2008. Measles seropositivity declined continuously in age groups. The birth cohorts 1994–1996 showed significantly lower levels of seropositivity and GMT than did the other birth cohorts.

Conclusion

Despite efforts to eliminate measles for the past 10 years in Korea, our study revealed specific birth cohorts remaining at risk for transmission. The adolescents born during 1994–1996 had the lowest measles seropositivity levels, and might represent a ‘pocket’ that has potential at increased risk for measles transmission. Further discussion for follow-up immunization should be placed for consideration in the near future.     

The present and future burden of previously treated advanced non-small cell lung cancer (NSCLC) by histology and line of therapy in France,Germany, Italy,and Spain: model-based predictions

Background

The burden of advanced non-small cell lung cancer (NSCLC) is not well understood, and the number of patients likely to receive treatment in Europe has not been quantified. The aim of this study was to forecast the annual number of patients with squamous and non-squamous advanced NSCLC likely to receive second and third lines of therapy (LOT) from 2016 to 2020 in France, Germany, Italy, and Spain.

Methods

A patient count model (PCM) was developed in Microsoft Excel to estimate the number of patients with refractory advanced NSCLC eligible to receive systemic treatment. Using historical population-based cancer registry data, segmented linear regression (“Joinpoint”) was used to forecast age- and sex-stratified lung cancer incidence rates in each country through 2020. Yearly incident case count totals by country were apportioned according to NSCLC histology and stage at diagnosis. Country-specific treatment rates came from a recent medical chart review study, and early- to advanced-stage disease progression rates were estimated over a 10-year interval. A probabilistic sensitivity analysis (PSA) was performed to estimate variability in the patient counts.

Results

The combined number of squamous and non-squamous advanced NSCLC patients estimated to receive second and third LOT, respectively, in 2016 were France?=?11,600 and 3500; Germany?=?15,100 and 4900; Italy?=?13,500 and 2500; Spain?=?9400 and 2100. The forecasted numbers of patients receiving second and third LOT, respectively, in 2020 were France?=?13,900 and 4200; Germany?=?16,200 and 5200; Italy?=?15,100 and 2600; Spain?=?11,000 and 2500.

Conclusions

Driven by growth in the incidence of NSCLC among women, the model forecasts an overall increase in the number of patients with advanced-stage squamous and non-squamous NSCLC likely to receive systemic treatment in the year 2020. The results highlight the significant burden of refractory advanced NSCLC and the need for more robust surveillance data to accurately quantify the burden of disease.

     

Long-term Trends in Incidence and Mortality of Intrahepatic and Extrahepatic Bile Duct Cancer in Japan

Background

A report of multiple cases of bile duct cancer at a Japanese printing company raised concern about such cancers. We examined long-term trends in bile duct cancer in Japan.

Methods

Data from 4 population-based cancer registries were used to calculate incidence between 1985 and 2007, and vital statistics were used to estimate mortality between 1985 and 2011. Age-standardized rates were calculated and analyzed using a joinpoint regression model.

Results

Among men, the incidence rate of intrahepatic bile duct cancer increased throughout the observation period; among women, it increased until 1996–1998 and remained stable thereafter. The incidence rate of extrahepatic bile duct cancer was stable in men and decreased from 1993–1995 in women. In people aged 30 to 49 years, the incidence rates of intra- and extrahepatic bile duct cancer remained stable or decreased. The mortality rate of intrahepatic bile duct cancer increased in both sexes and in all age groups since 1996, while that of extrahepatic bile duct cancer decreased since 1992. In people aged 30 to 49 years, the mortality rates of intra- and extrahepatic bile duct cancer remained stable and decreased, respectively.

Conclusions

The incidence and mortality rates of intrahepatic bile duct cancer remained stable or increased throughout the observation period. The incidence rate of extrahepatic bile duct cancer remained stable or decreased, and the mortality rate decreased since 1992. In people aged 30 to 49 years, the incidence and mortality rates of intra- and extrahepatic bile cancer remained stable or decreased.Key words: intrahepatic bile duct cancer, extrahepatic bile duct cancer, incidence, mortality     

Analysis of age–period–cohort effects on overall mortality in Andalusia (Southern Spain)

Objectives

To evaluate the age–period–cohort effects on overall mortality in Andalusia (Spain).

Study design

An ecological study was implemented with a Lexis diagram triangle comprising each annual age group, year of death and year of birth as the unit of analysis.

Methods

In all 1,384,899 deaths from all causes were analysed for individuals between the ages of 1 and 84 years who died in Andalusia in the period 1981–2008. A non-linear regression model was estimated for each gender group and geographical area. The effects of age, year of death and birth cohort were parameterized using B-spline smoothing functions.

Results

There is a downward trend in mortality by age to around the age of 15 years, from which point the trend turned upwards. For cohorts born between 1945 and 1965, the rate climbed steadily. From 1965, the rate turned downwards. Death rates increased between 1995 and 2000, only to turn down again until the end of the period. Broadly, these results were similar for both men and women, in all the provinces of Andalusia and for Andalusia as a whole.

Conclusions

This study points to an age–period–cohort effect on deaths from all causes in all the geographic areas studied.     

Use of surveillance data to estimate the effectiveness of the 7-valent conjugate pneumococcal vaccine in children less than 5 years of age over a 9 year period

Background

Case–control studies evaluating post-licensure effectiveness of conjugate vaccines can be laborious and costly. We applied an indirect cohort method to evaluate the effectiveness of seven-valent pneumococcal conjugate vaccine (PCV7) against invasive pneumococcal disease (IPD) and compared the results to the effectiveness measured using a standard case–control study conducted during the same time period.

Methods

IPD cases among children 2–59 months old were identified through the Active Bacterial Core surveillance system during 2001–2009. We used logistic regression to calculate the odds ratio of vaccination (versus no vaccination) among cases (PCV7-type IPD cases) and non-cases (non-PCV7-type IPD cases), controlling for the presence of underlying conditions. Vaccine effectiveness (VE) was calculated as one minus the adjusted odds ratio.

Results

Among 4225 IPD cases reported during 2001–2009, 2680 (63%) had serotype information and vaccine history. Effectiveness of ≥1 dose of PCV7 against PCV7-types was 88% (95% confidence interval (CI) 78–94%) among children with comorbid conditions and 97% (95% CI 92–98%) among healthy children. Among healthy children, VE was higher in 2001–2003 (97%, 95% CI 95–98%) compared to 2004–2009 (81%, 95% CI 64–90%). The annual estimates of VE in 2004–2009 showed great variability and wide confidence intervals due to the small number of PCV7-type cases.

Conclusions

An indirect cohort design using IPD surveillance data confirms the findings of the case–control study and, therefore, appears suitable for estimating PCV7effectiveness. This method would be most useful shortly after vaccine introduction, and less useful in a setting of very high vaccine coverage and fewer vaccine-type cases.     

Four years of universal pneumococcal conjugate infant vaccination in Germany: Impact on incidence of invasive pneumococcal disease and serotype distribution in children

Introduction

Vaccination with pneumococcal conjugate vaccine (PCV) for all children <2 years was recommended in Germany in July 2006. Initially PCV7 was exclusively used; PCV10 became available from April 2009 and PCV7 was replaced by PCV13 in December 2009.

Objective

To compare the incidence and serotype distribution of invasive pneumococcal disease (IPD) for pneumococcal meningitis and non-meningitis IPD in children from 2007 to 2010 with reference to the pre-vaccination period from 1997 to 2001.

Methods

Nationwide surveillance of IPD for children <16 years in Germany was based on two independent reporting sources: active surveillance in paediatric hospitals and passive web-based surveillance through microbiological laboratories. Serotyping was performed using the Neufeld Quellung reaction. Case definition: isolation of Streptococcus pneumoniae from a normally sterile body site. IPD incidence was estimated by capture–recapture analysis. Rate ratios comparing post- to pre-vaccination incidence were calculated as well as PCV7 and non-PCV7 serotype specific incidences.

Results

While PCV7 incidence decreased by 88% (95%CI: 83 to 91) in children <16 years both in pneumococcal meningitis and non-meningitis IPD, an increase in Non-PCV7 serotypes was observed which was more pronounced in non-meningitis cases (168%; 95%CI: 140–257) than in pneumoccocal meningitis (65%; 95%CI: 23–123). The changes in incidence after four years were: <16 years: −35% (95%CI: −49 to −19), <2 years: −46% (95%CI: −61 to −27) for pneumococcal meningitis and + 11% (95%CI: −4 to  + 29) and −26% (95%CI: −41 to −7) for non-meningitis IPD respectively.

Conclusion

Infant PCV7 vaccination in Germany prompted a decrease in the incidence of pneumococcal meningitis similar to that observed in England/Wales. In non-meningitis IPD the decrease was smaller and confined to the age group <2 years with no change or an increase in incidence in other age groups pointing to potential ascertainment bias due to increased blood-culturing.