Trends in mortality from hepatocellular carcinoma in Europe, 1980-2004

Upward trends in mortality from hepatocellular carcinoma (HCC) were recently reported in the United States and Japan. Comprehensive analyses of most recent data for European countries are not available. Age-standardized (world standard) HCC rates per 100,000 (at all ages, at age 20-44, and age 45-59 years) were computed for 23 European countries over the period 1980-2004 using data from the World Health Organization. Joinpoint regression analysis was used to identify significant changes in trends, and annual percent change were computed. Male overall mortality from HCC increased in Austria, Germany, Switzerland, and other western countries, while it significantly decreased over recent years in countries such as France and Italy, which had large upward trends until the mid-1990s. In the early 2000s, among countries allowing distinction between HCC and other liver cancers, the highest HCC rates in men were in France (6.8/100,000), Italy (6.7), and Switzerland (5.9), whereas the lowest ones were in Norway (1.0), Ireland (0.8), and Sweden (0.7). In women, a slight increase in overall HCC mortality was observed in Spain and Switzerland, while mortality decreased in several other European countries, particularly since the mid-1990s. In the early 2000s, female HCC mortality rates were highest in Italy (1.9/100,000), Switzerland (1.8), and Spain (1.5) and lowest in Greece, Ireland, and Sweden (0.3). In most countries, trends at age 45-59 years were consistent with overall ones, whereas they were more favorable at age 20-44 years in both sexes. CONCLUSION: HCC mortality remains largely variable across Europe. Favorable trends were observed in several European countries mainly over the last decade, particularly in women and in young adults.     

Worldwide mortality from cirrhosis: an update to 2002

BACKGROUND/AIMS: Cirrhosis mortality has registered large changes over the last few decades. METHODS: Age-standardized (world standard) cirrhosis mortality rates per 100,000 were computed for 41 countries worldwide over the period 1980-2002 using data from the WHO mortality database. RESULTS: In the early 1980s, the highest rates were in Mexico, Chile (around 55/100,000 men and over 14/100,000 women), France, Italy, Portugal, Austria, Hungary and Romania (around 30-35/100,000 men and 10-15/100,000 women). Mortality from cirrhosis has been steadily declining in most countries worldwide since the mid or late 1970s (annual percent change, APC, between -5% and -1.5% in the last decade only for both sexes). In southern Europe, rates in the early 2000s were less than halved compared to earlier decades. In contrast, rates have been rising in Eastern European countries to reach extremely high values in the mid 1990s, and declined only thereafter. In the UK rates were still steadily rising (APC around +7% in men and +3% in women from England and Wales, and +9% in men and +7% in women from Scotland). CONCLUSIONS: Mortality from cirrhosis shows favourable trends in most countries of the world, following the reduction in alcohol consumption and hepatitis B and C virus infection. The steady upward trends observed over more recent calendar periods in the UK and central and eastern European countries are attributed to the persistent increase in the prevalence of alcohol consumption.     

Worldwide mortality from cirrhosis

Background/Aims: Cirrhosis mortality has registered large changes over the last few decades. Aim: To report worldwide mortality due to cirrhosis over the period 1980-2002.Methods: Age-standardized (world standard) cirrhosis mortality rates per 100,000 were computed for 41 countries worldwide over the period 1980-2002 using data from WHO mortality database.Results: In the early 1980s, the highest rates were in Mexico, Chile (around 55/100,000 men and 14/100,000 women), France, Italy, Portugal, Austria, Hungary and Romania (around 30-35/100,000 men and 10-15/ 100,000 women). Mortality from cirrhosis has been steadily declining in most countries worldwide since the mid or late 1970s (annual percent change, APC, between -5% and -1.5% in the last decade only for both sexes). In southern Europe, rates in the early 2000s were less than halved compared to earlier decades. In contrast, rates have been rising in Eastern European countries to reach extremely high values in the mid 1990s, and declined only thereafter. In the UK rates were still steadily rising (APC around +7% in men and +3% in women from England and Wales, and +9% in men and +7% in women from Scotland). Conclusions: Mortality from cirrhosis shows favourable trends in most countries of the world, following the reduction in alcohol consumption and hepatitis B and C virus infection. The steady upward trends observed over more recent calendar periods in the UK and central and eastern European countries are attributed to the persistent increase in the prevalence of alcohol consumption.Abstract published under the permision of the editor of J Hepatol     

Descriptive epidemiology of thyroid cancer in the Swiss Canton of Vaud

Although substantial decreases have been recorded, age-standardized mortality rates from thyroid cancer in Switzerland are still the highest in Europe in men (0.9/100,000), together with those from Austria, and the third highest (1.0/100,000) in women. Detailed analysis of 308 new cases registered between 1974 and 1987 in the Swiss Canton of Vaud revealed an overall incidence rate of 1.36/100,000 men (world standard) in 1974-1980 and of 1.74/100,000 in 1981-1987. Corresponding values for women were 4.28 and 4.51, respectively. Thus, women constituted the majority of all cases (76%). Papillary carcinoma was the most frequent histological type (53%) followed by follicular (27%), undifferentiated (5%) and medullary (2%); other morphologies and clinical tumours accounted for 13% of the whole series. In both sexes, most of the apparent increase over the calendar period was restricted to the papillary type. Overall 5- and 10-year survival rates were 71% and 57%. When various factors were introduced in a Cox proportional-hazard model, young age at diagnosis (hazard rate for greater than or equal to 65 years vs less than 45 = 14.7; 95% confidence interval = 7.5-29.1) and good histological differentiation (hazard rate for papillary and follicular vs undifferentiated = 0.4) emerged as strong favourable and independent prognostic factors. The reduced hazard rate for women, other factors being equal, was of borderline significance (0.7, 95% confidence interval = 0.5-1.0), whereas no significant difference was observed between follicular and papillary carcinomas, and calendar periods of diagnosis.     

Asthma Mortality and Long-Acting Beta2-Agonists in Five Major European Countries, 1994–2004

Objectives. Over the last few decades, important changes occurred in the pharmacological approach to asthma control. However, the possible link between pharmacologic treatment and asthma death remains controversial. Study Design and Setting. Age-standardized asthma mortality rates were computed over the 1994–2004 period for France, Germany, Spain, the UK, and Italy. Rates for children and young adults 5 to 34 years of age, middle age adults 35 to 64 years of age, and elderly adults ≥ 65 years. Joinpoint regression was performed to identify years where significant changes in mortality trends occurred. Consumption of inhaled long-acting beta-2-agonists (LABA), including inhaled corticosteroids (ICS) when combined with LABAs in a single inhaler, derived from sales estimates. Results. In 1994, the highest asthma mortality rates were in Germany (4.7/100,000), and the lowest ones were in Italy and Spain (0.5/100,000). Steady downward trends were observed in all the countries considered. The largest decline was registered in Germany and the smallest one was in the UK. LABA sales increased steadily since 1994, particularly in France, Spain, and the UK, reaching values around 14 Defined Daily Doses (DDD)/1,000 inhabitants in 2004. Conclusion. While the use of LABAs (with or without ICS) increased over the last decade, asthma mortality declined in major western European countries.     

Regional differences in mortality: a comparison between Austria, Hungary and Switzerland

BACKGROUND: Important differences in mortality rates exist even between neighbouring countries. This should facilitate the identification of the lifestyle parameters underlying these differences. The mortality rates obtained in Hungary, Austria and Switzerland were compared. METHODS: The mortality rates for all-cause, total cardiovascular, total cancer and stroke mortality were obtained from a special tape from WHO. Nutritional data were obtained from FAO food balance sheets and from dietary surveys. Gompertz and polynomial equations were calculated from the age-specific mortality rates. FINDINGS: Great differences in mortality exist between the three countries. In the period from 1950 until 1995 mortality decreased in Austria and Switzerland, but increased in Hungary. In men, total cancer and total cardiovascular mortality also increased markedly in Hungary during the last 20 years. Hungary has a lower dietary P/S ratio, a higher level of animal/vegetal fat and a lower consumption of fruit than Austria and Switzerland, combined with a high level of salt consumption. The level of cigarette smoking is similar in Hungary and Switzerland. The increase in mortality rate in Hungary is less pronounced in women than in men. INTERPRETATION: The major differences in lifestyle between the three countries concern socio-economic and nutritional patterns. Epidemiological evidence favours nutrition as the most important determinant of the differences in mortality rates between the three countries.     

How are industrialized nations responding to the social security crisis?

The 24-member nations of OECD are: Australia, Austria, Belgium, Canada, Denmark, Finland, France, the Federal Republic of Germany, Greece, Iceland, Ireland, Italy, Japan, Luxembourg, the Netherlands, New Zealand, Norway, Portugal, Spain, Sweden, Switzerland, Turkey, the United Kingdom and the United States.     

The influence of alcohol consumption and hepatitis B and C infections on the risk of liver cancer in Europe

BACKGROUND/AIMS: To assess the variability of liver cancer (LC) risk associated with hepatitis B (HBV) and hepatitis C (HCV) viruses and alcohol intake in 2002 throughout Europe. METHODS: Incidence data were obtained from population-based cancer registries whereas mortality, HBV, HCV and alcohol exposures were obtained from the WHO databases. Relative risk of LC and their posterior probabilities to be >1 were obtained and plotted in maps through a Bayesian random effects model. RESULTS: HBV prevalence >2% increased the risk of developing LC a 15% in men and 21% in women; HCV prevalence >2%, 54% in men and 33% in women and, pure alcohol intake >11l, 26% and 14%, respectively (all of them statistically significant). These risk factors played a similar role in the risk of dying from LC among men, whereas HBV and alcohol were not statistically significant among women. Significant high LC risk, after HBV/HCV and alcohol adjustment were observed for both sexes in: Hungary, Moldova, Romania, Croatia, Greece, Italy, Spain, France and Austria. CONCLUSIONS: South-North and East-West decreasing gradients for LC risk were observed in Europe. HBV, alcohol and, mainly, HCV are independent risk factors that could explain this geographical pattern.     

Temporo-spatial epidemiology of cancer of the pancreas. Study of international and French mortality

The aim of this study was to describe the main geographical and chronological epidemiologic characteristics of the mortality rates for pancreatic cancer (PC) in France and in other countries. The international geographical study shows PC standardized rates ranging from 3.1 to 9.9/100,000 for men and from 2.1 to 7.2/100,000 for women. Higher rates are observed in Northern and Eastern Europe, as well as in North America. In France, mortality rates decrease from the North-East to the South-West of the country. During the period 1950-1980, the median annual increase in PC mortality rates was 3 p. 100 for men, and 2.5 p. 100 for women in the countries studied. The increase was greater where initial PC mortality rates were low. This trend has slowed down during the last ten years (1971-1980). In France, annual PC mortality rates have increased more for men (+ 3.46 p. 100) than for women (+ 1.94 p. 100). There is evidence of an increased PC mortality rate from one generation to another. Cohort analysis points to a significant stabilization of PC mortality rates for women in France.     

Estimated numbers and prevalence of PI*S and PI*Z alleles of alpha1-antitrypsin deficiency in European countries.

The current study focuses on developing estimates of the numbers of individuals carrying the two most common deficiency alleles, PI*S and PI*Z, for alpha1-antitrypsin deficiency (AT-D) in Europe. Criteria for selection of epidemiological studies were: 1) AT phenotyping performed by isoelectrofocusing or antigen-antibody crossed electrophoresis; 2) rejection of "screening studies"; 3) statistical precision factor score of > or = 5 for Southwest, Western and Northern Europe, > or = 4 for Central Europe, > or = 3 for Eastern Europe; and 4) samples representative of the general population. A total of 75,390 individuals were selected from 21 European countries (one each from Austria, Belgium, Latvia, Hungary, Serbia-Montenegro, Sweden and Switzerland; two each from Denmark, Estonia and Lithuania; three each from Portugal and the UK; four each from Finland, The Netherlands, Norway and Spain; five each from Russia and Germany; six from Poland; eight from Italy; and nine from France). The total AT-D populations of a particular phenotype in the countries selected were: 124,594 ZZ; 560,515 SZ; 16,323,226 MZ; 630,401 SS; and 36,716,819 MS. The largest number of ZZ (5,000-15,000) were in Italy, Spain, Germany, France, the UK, Latvia, Sweden and Denmark, followed by Belgium, Portugal, Serbia-Montenegro, Russia, The Netherlands, Norway and Austria (1,000-2,000), with < 1,000 in each of the remaining countries. A remarkable lack in number of reliable epidemiological studies and marked differences among these European countries and regions within a given country was also found.     

Risk factors for the rising rates of primary liver cancer in the United States

BACKGROUND: A recent increase in the incidence of hepatocellular carcinoma was reported in the United States. The cause of this witnessed rise remains unknown. METHODS: We examined the temporal changes in both age-specific and age-standardized hospitalization rates of primary liver cancer associated with hepatitis C, hepatitis B, and alcoholic cirrhosis in the Department of Veterans Affairs Medical Center's Patient Treatment File. RESULTS: A total of 1605 patients were diagnosed with primary liver cancer between 1993 and 1998. The overall age-adjusted proportional hospitalization rate for primary liver cancer increased from 36.4 per 100,000 (95% confidence interval [CI], 34.0-38.9) between 1993 and 1995 to 47.5 per 100,000 (95% CI, 44.6-50.1) between 1996 and 1998. There was a 3-fold increase in the age-adjusted rates for primary liver cancer associated with hepatitis C virus, from 2.3 per 100,000 (95% CI, 1. 8-3.0) between 1993 and 1995 to 7.0 per 100,000 (95% CI, 5.9-8.1) between 1996 and 1998. Concomitant with this rise, the age-specific rates for primary liver cancer associated with hepatitis C also shifted toward younger patients. During the same periods, the age-adjusted rates for primary liver cancer associated with either hepatitis B virus (2.2 vs 3.1 per 100,000) or alcoholic cirrhosis (8. 4 vs 9.1 per 100,000) remained stable. The rates for primary liver cancer without risk factors also remained without a statistically significant change, from 17.5 (95% CI, 15.8-19.1) between 1993 and 1995 to 19.0 per 100,000 (95% CI, 17.3-20.7) between 1996 and 1998. CONCLUSIONS: Hepatitis C virus infection accounts for most of the increase in the number of cases of primary liver cancer among US veterans. The rates of primary liver cancer associated with alcoholic cirrhosis and hepatitis B virus infection have remained stable. Arch Intern Med. 2000;160:3227-3230.     

Prostate cancer incidence and mortality trends among elderly and adult Europeans

Prostate cancer is a common malignancy primarily of elderly men, with incidence rates rapidly increasing, owing to the population ageing and the introduction of more sensitive diagnostic procedures. Although the effectiveness of a screening test remains controversial, the decreasing mortality rates, which recently emerged in the USA, may be partly attributable to the changes of patterns of care, thus suggesting a potential effect of preventive measure. The object of this study is to examine time trends in incidence and mortality from prostate cancer in European Union (EU) countries, with particular attention to possible differences between the elderly (65 years old or over) and younger or middle age adults (35-64 years old). EUROCIM, the data base created by the European Network of Cancer Registries, provided the incidence and mortality data for the 12 EU Countries analysed (namely: Finland, Denmark, Scotland, England and Wales, Ireland and The Netherlands in Northern Europe; Austria, Germany and France in Central Europe; Italy, Spain and Portugal in Southern Europe), for the 1978-1994 period. Incidence and mortality time trends, expressed as mean difference per cent (MD%) per year, were estimated by a Poisson log-linear regression model. Higher resolution analyses were also carried out to check differences in time trends by age class within the two groups under study. Upward mortality trends occurred in several countries, excepting Ireland, Austria and Southern Europe, but only for younger and middle aged adults. Rates increased more rapidly in older age groups; a clear north-south gradient appeared both in the elderly and in younger adults; for the elderly, MD% higher than +1.5 for most countries of Northern Europe, MD% around +1 for Central Europe, and MD% less than +1 for Southern Europe were registered, with lower values for younger people. Incidence rates rose across the period considered, almost in all countries both for elderly and for younger and middle age adults, increasing more rapidly in younger age. Incidence trends showed a less clear geographic pattern than for mortality. In the younger group, high MD%, ranging in Northern Europe from +3.2 in Finland and England and Wales to +5.7 in The Netherlands, were observed, while in the South values ranged between +4.2 and +5.0. In Central Europe, very high MD%, ranging between +8.4 in France and +16.6 in Austria, were noted. No significant trends were observed for Denmark, Ireland and Portugal. For the elderly the increase was generally lower and no significant trend was observed in Germany and Portugal. Interaction between age and calendar period in the older group was observed for most of the considered countries. With reference to mortality, the MD% showed a tendency to rise, with increasing age, while no consistent pattern emerged for incidence. The observed incidence trends are probably a consequence of the different times in which the more recent detection methods were introduced in each country, and of the different policies adopted by each health care system towards the elderly. A comparison with the USA data suggests that in the next future a favourable downward mortality trend could be expected also in some EU Countries and, particularly, for younger age groups, even though prostatic cancer in old patients will remain a great burden, which National Health Care Systems will have to face in the next decades.     

Digestive cancer mortality in a Mediterranean urban area (Barcelona, 1983-1987)

This study presents the main epidemiologic features of general, site and age-specific, and premature mortality due to digestive cancer in Barcelona residents in the 1983-87 period, selecting death certificates where digestive cancer was coded as the primary cause of death (codes 150 to 159 of the ICD-9). Eight percent (6,269) of all deaths were due to malignant neoplasms of the digestive system, representing 30.3% of all deaths due to neoplasms. The main contribution was due to gastric cancer (18.8 cases per 100,000) and colon cancer (17.2 per 100,000), followed by rectal cancer (8.8 per 100,000) and pancreatic cancer (8.7 per 100,000). The annual increase in colon cancer among women--where it is the main digestive cancer site was statistically significant. Premature deaths due to digestive cancer yielded 3.5 years of potential life lost per 1,000 people (21.8% of all premature cancer deaths). In men, most cases of these premature deaths were due to gastric cancer (24.3%), while in women premature deaths were more often due to colon cancer (25.3%). Excess mortality due to esophagus, stomach and liver cancer was observed in Ciutat Vella, the most socioeconomically deprived district in Barcelona.     

Incidence and mortality of primary sclerosing cholangitis in the UK: a population-based cohort study

BACKGROUND/AIMS: Little is known about the occurrence of Primary Sclerosing Cholangitis (PSC) in the population of the United Kingdom or its associated risks of mortality and malignancy. We aimed to fill these gaps in knowledge. METHODS: We identified 223 people with PSC and 2217 control subjects from the General Practice Research Database in the UK. We calculated incidence rates (1991-2001) and mortality rates and used Poisson and Cox regression to make comparisons between populations. RESULTS: There were 149 incident cases giving a rate of 0.41 per 100,000 person years (95% CI 0.34-0.48) and a prevalence in 2001 of 3.85 per 100,000 (95% CI 3.04 to 4.80). The incidence of PSC increased about 50% over the period studied and was higher in men compared with women. There was a three-fold mortality rate increase (Hazard ratio 2.92 (95% CI 2.16-3.94) in people with PSC compared to the general population, a two-fold increase in risk of any malignancy and a 40-fold increase in the risk of primary liver cancer (HR 2.23 and 37.44, respectively). CONCLUSIONS: We believe this paper provides the most reliable estimates of the occurrence of PSC and of its risk in terms of death and malignancy in the UK available to date.     

Hepatocellular carcinoma: trends of incidence and survival in Europe and the United States at the end of the 20th century

OBJECTIVES: There is large geographic variation in incidence levels and time trends of hepatocellular carcinoma. We compared population-based liver cancer incidence and survival in European and U.S. populations in order to elucidate geographic differences and time trends for these variables. METHODS: Since comparisons based on cancer registry data are problematic because of variations in liver cancer definition and coding, we considered a subset of cases likely to be mainly hepatocellular carcinoma, suitable for international comparison. Incidence and 5-yr relative survival were calculated from cases diagnosed in five European regions (30,423 cases) and the United States (6,976 cases) in 1982-1994. RESULTS: Age-standardized incidence was highest in southern Europe (12/100,000 in men and 3/100,000 in women in 1992-94) and lowest in northern Europe, where incidence was similar to that of the United States (3/100,000 in men, <1/100,000 in women). Over the study period, incidence remained stable in the United States and most of Europe, except for a notable increase in southern Europe. Five-year relative survival was <10% in Europe, ranging from 8% (southern Europe) to 5% (eastern Europe), and 6% in the United States. Survival increased slightly with time, mainly in southern Europe and was unaffected by sex, but was better in younger patients. CONCLUSIONS: Increasing incidence in southern Europe is probably related to hepatitis B and C infection and increasing alcohol intake, while improving survival may be due to greater surveillance for cirrhosis. The survival gap between clinical and population-based series suggests management is better in centers of excellence.     

Later life health in Europe: how important are country level influences?

In this article, we examine the extent and pattern of country level differences in later life health in Europe and compare five competing explanations for this variation. We used data from 14 European countries, drawn from Northern (Denmark and Sweden), Western (Austria, France, Ireland, Germany Belgium, the Netherlands and Switzerland), Mediterranean (Spain, Italy and Greece) and Eastern (Poland and Czechia) regions of Europe, N = 33,528. Our results suggest that about a quarter (24%) of the overall variation in later life health in Europe appears to be due to country level differences. The Scandinavian countries along with Germany, the Netherlands and Switzerland appear to have the best health, whereas Spain, Italy and Poland had the lowest health score. Country level influences on health were largely associated with differences in the level of egalitarianism of each country as measured by the Gini coefficient, with more inequality being associated with poorer health. Differences in health-related lifestyle, as approximated by the prevalence of obesity in each country, also had a substantial macrolevel influence on later life health, with a lower national prevalence of obesity being associated with better health. Our results indicate the presence of systematic macrolevel health variation in Europe and suggest that policies to reduce income inequality as well as population interventions to promote healthier lifestyles and decrease the prevalence of obesity have the potential to improve population health and potentially offset some of the challenges posed by population ageing in Europe.     

Optimizing use of revascularization and clinical outcomes in ST-elevation myocardial infarction: insights from the GUSTO-V trial.

AIMS: To examine the relationship between revascularization within 7 days and 1-year mortality among ST-elevation myocardial infarction patients enrolled in GUSTO-V trial (n=13 451). To examine the relative contribution of system and patient level factors to the variation in international revascularization rates, and their impact on mortality outcomes. METHODS AND RESULTS: Patients from North America (USA, Canada), Australia, and Europe (UK, France, Germany, Italy, Spain, Poland, Norway, The Netherlands, Belgium, Finland) were included in the study. Revascularization was associated with lower 1-year mortality. Norway, Belgium, Spain, Poland, and Italy also had lower than expected revascularization rates but higher than expected mortality rates. France and USA had almost two times the expected rate of 7-day revascularization, which was associated with modest mortality benefits. Patients' propensity for revascularization based on clinical factors alone was associated with lower 1-year mortality (OR 0.97, 95% CI: 0.96-0.99). Country-level factors had an impact on propensity for revascularization but no impact on 1-year mortality. CONCLUSION: Our study reveals the potential for some countries with lower than expected 7-day revascularization rates to improve their clinical outcomes. Also highlighted is the possibility for more economically efficient delivery of care in USA and France.