Spatial differences in mortality and morbidity from cancer of the lip,oral cavity and pharynx in Hungary

In evaluating the health state of the population one of the most reliable parameter is mortality. The development of statistical and spatial analytical methods gave a tool for evaluating mortality and morbidity in small areas. GIS mapping helps in the assessment of health state of small areas, to investigate causal relationship and create plans of intervention. Within the frames of the National Environmental Health Action Programme (NEHAP, 1996) a spatial statistical information system was elaborated. By the help of this system, mortality from cancer of the lip, oral cavity and pharynx (ICD-X.: C00-C14) was analysed for 1986-1997 and morbidity for 1997-1999 by computing standardised mortality and morbidity ratio. Regions with unfavourable mortality and morbidity were defined, statistical significance was tested. After age and gender stratification, a cluster analysis was also carried out. An international comparison of mortality was done as well. According to our data, mortality - most frequent in both sexes according to the international comparison - as well as morbidity showed a typical spatial distribution. An excess in mortality and morbidity is observable in the central part of the country, as well as in the Northern part and in traditional wine producing areas. The spatial accumulation of mortality is very similar to that of mortality from chronic liver diseases (ICD-X.: K70). In the primary prevention of oral cancer smoking cessation and the decrease of alcohol consumption is of great importance. Screening activity of GPs and dental doctors is of major importance in secondary prevention.     

Cancer risks in the Kaluga oblast of the Russian Federation 10 years after the Chernobyl accident

Cancer morbidity and mortality were studied in areas of the Kaluga oblast contaminated with radionuclides. The main objective of the study was to assess the influence of radiation exposure on existing levels of cancer morbidity and mortality. Time trends and relative population risks were analysed. Based on this analysis, it was concluded that the current levels of morbidity from cancers among the populations residing in the studied areas were primarily a result of a complex of factors which predated the exposure from the Chernobyl accident. However, there seems to be an unfavourable trend concerning malignant neoplasms of the respiratory organs for women residing in the contaminated areas. To date, no statistically significant effect of radiation on cancer morbidity (except for thyroid cancer in women) has been noted. The levels of cancer morbidity and mortality in the contaminated areas generally reflect the changes in cancer incidence in the oblast as a whole. The findings are consistent with international data on latent periods for the induction of radiogenic cancers and the biological effects for similar levels of exposure to populations residing in contaminated territories. Further studies are necessary in order to monitor possible effects that are related to the accident.     

Can Global Variation of Nasopharynx Cancer Be Retrieved from the Combined Analyses of IARC Cancer Information (CIN) Databases?

Background

The international nasopharynx cancer (NPC) burdens are masked due to the lack of integrated studies that examine epidemiological data based on up-to-date international disease databases such as the Cancer Information (CIN) databases provided by the International Agency for Research on Cancer (IARC).

Methods

By analyzing the most recently updated NPC epidemiological data available from IARC, we tried to retrieve the worldwide NPC burden and patterns from combined analysis with GLOBOCAN2008 and the Cancer Incidence in Five Continents (CI5) databases. We provide age-standardized rates (ASR) for NPC mortality in 20 highest cancer registries from GLOBOCAN2008 and the World Health Organization (WHO) mortality databases, respectively. However, NPC incidence data can not be retrieved since it is not individually listed in CI5 database. The trend of NPC mortality was investigated with Joinpoint analysis in the selected countries/regions with high ASR.

Results

GLOBOCAN 2008 revealed that the highest NPC incidence rates in 2008 were in registries from South-Eastern Asia, Micronesia and Southern Africa with Malaysia, Indonesia and Singapore ranking the top 3. WHO mortality database analysis revealed that China Hong Kong, Singapore and Malta ranks the top 3 regions with the highest 5-year mortality rates.

Conclusions

NPC mortality rate is about 2–3 times higher in male than that in female, and shows decrease tendency in those selected countries/regions during the analyzed periods. However, the integrated analyses of the current IARC CIN databases may not be suitable to retrieve epidemiological data of NPC. Much effort is required to improve the local cancer entry and regional death-reporting systems so as to aid similar studies.     

Methodological aspects of the evaluation of epidemiological safety in maternity hospitals

The distribution of morbidity and mortality in newborns, as well as morbidity of parturient women, in maternity hospitals of Moscow official have been analyzed according to statistical data for 1996-1999. The methods of cluster analysis (k-medium and tree classification by the method of the next door neighbours) were used. The evaluation of the stability of the distribution of morbidity and mortality in maternity hospitals was made with the use of chi 2 criterion. The specific features of the distribution of morbidity and mortality of newborns, as well as morbidity of parturient women, in the hospitals under study were detected. The methodological approach to the evaluation of epidemiological safety in maternity hospitals was proposed.     

Evaluating the epidemiological impact of national control programmes for helminths

During the past decade, there has been renewed commitment to programmes for helminth control, and several international initiatives have been launched. Scientific evaluation of large-scale interventions to reduce the incidence of infection and associated morbidity and mortality is vital, not only to demonstrate health benefits, but also to assess cost-effectiveness to show that monies from donor agencies have been used wisely. Using the example of schistosomiasis, this article outlines a framework for the evaluation of the impact of national control programmes, highlighting the important epidemiological and practical issues that must be addressed.     

Combating malaria morbidity and mortality by reducing transmission

Jean-Fran?ois Trape and Christophe Rogier present epidemiological data and an analysis of the relationship between transmission, morbidity and mortality from malaria which suggest that any intervention aiming to reduce transmission will not, on a long-term basis, reduce the burden of malaria in the majority of epidemiological contexts observed in tropical Africa.     

Systemic inflammation and mortality in chronic obstructive pulmonary disease

Cardiovascular diseases and cancer (especially lung cancer) are leading causes of morbidity and mortality in patients with chronic obstructive pulmonary disease (COPD). Some have implicated systemic inflammation, which is commonly observed in COPD, as the potential mechanistic bridge between COPD and these disorders. This concept has been supported by animal studies especially in rabbits, which have clearly demonstrated the effect of local lung inflammation on systemic inflammation and on the progression of atherosclerosis and by cross-sectional population-based studies, which have shown a significant relationship between systemic inflammation, as measured by circulating C-reactive protein (CRP) and the risk of cardiovascular diseases in COPD patients. These data have been further extended by a recent study that has elucidated the temporal nature of the relationship between systemic inflammation and the risk of cardiovascular events and cancer in COPD patients. This study showed that baseline CRP levels predicted the incidence of cardiovascular events and cancer-specific mortality over 7 to 8 years of follow-up. CRP levels also predicted all-cause mortality. Collectively, these data indicate that systemic inflammation may play an important role in mediating the extra-pulmonary complications of COPD. Systemic inflammation may contribute substantially to the overall morbidity and mortality of COPD patients.     

Epidemiology of laryngeal cancer in Brazil: Historical data from 2000 to 2019

IntroductionTo determine the incidence, morbidity, and mortality rate of laryngeal cancer in two decades and its epidemiological, clinical, and histological characteristics by sex in Brazil.MethodsThis ecological study used three reliable sources of secondary data: population- and hospital-based cancer registries and the national mortality database. All data available from 2000 to 2019 were considered.ResultsThe incidence of male laryngeal cancer decreased from 9.20 to 4.95 per 100,000 from 2000 to 2018, while mortality slightly decreased from 3.37 to 3.30 per 100,000 from 2000 to 2019. In the same period, the female incidence decreased from 1.26 to 0.48 per 100,000; however, mortality slightly increased from 0.34 to 0.36 per 100,000. Of 221,566 individuals with head and neck cancer, 27 % presented laryngeal cancer. The median age was 61 years (54−69), and most individuals were male (86.6 %), smokers (66.2 %), diagnosed with locally advanced cancer (66.7 %), and squamous cell carcinoma as the main histological type (93.2 %). Male tended to be older (p < 0.001), white (p < 0.001), smokers (p < 0.001), and present late treatment initiation (p < 0.001) and early death (p < 0.001) compared with female.ConclusionThe male laryngeal cancer affected mainly at productive age but with a decreased incidence, probably due to a reduction in smoking habit. However, mortality did not change, which may be explained by the late diagnosis and lack of access to radiotherapy.     

Health expectancy and the problem of substitute morbidity.

During the past century, the developed world has not only witnessed a dramatic increase in life expectancy (ageing), but also a concomitant rise in chronic disease and disability. Consequently, the tension between ''living longer'' on the one hand and health-related ''quality of life'' on the other has become an increasingly important health policy problem. The paper deals with two consequences of this so-called epidemiological transition in population health. The first one concerns the question of how--given the impressive changes--population health can be measured in an adequate and policy relevant present-day fashion. The second one is the so-called phenomenon of ''substitute morbidity and mortality'': more and more acute fatal diseases are replaced by non-fatal delayed degenerative diseases like dementia and arthritis. How the phenomenon of substitute morbidity and mortality affects the development of population health is illustrated with the epidemiological transitions, worldwide shifts in the main causes of death, assumptions used in models, adverse consequences of medical technologies and some results from intervention trials. Substitute morbidity and mortality may thwart our disease-specific expectations of interventions and asks for a shift to a ''total population health'' perspective when judging potential health gains of interventions. Better understanding of the dynamics that underly the changes in population health is necessary. Implications for data collections are more emphasis on morbidity data and their relation with mortality, more longitudinal studies, stricter requirements for intervention trials and more use of modelling as a tool. A final recommendation is the promotion of integrative measures of population health. For the latter several results are presented suggesting that, although the amount of morbidity and disability is growing with an increasing life expectancy, this is mild unhealthiness in particular. This finding supports the ''dynamic equilibrium'' theory. In absolute numbers, however, the burden of disease will continue to increase with further ageing of the population.     

Epidemiology, cancer genetics and microarrays: making correct inferences, using appropriate designs

Different disciplines approach cancer with different study designs, techniques and established bodies of knowledge. This article identifies some established epidemiological data and methods, which are useful for cross-disciplinary molecular and genetic studies of cancer but which are ignored by some researchers. First, the international variation in cancer risk is accounted for extensively by variation in environmental exposures; it is unlikely that even minute characterization of individual genomes will provide the best assessment of cancer risk in the absence of comparably detailed information on the environment. Second, epidemiological study-design methods are sometimes the most appropriate to answer molecular questions, particularly when using techniques such as expression microarrays or proteomics to establish differences among cancer subtypes or biomarkers in the setting of a non-experimental study. In such studies, it is essential to avoid bias, control confounding and undertake accurate replication. Established epidemiological data and methods will contribute to the best use of the new molecular technology.     

Topical problems in the study of remote effects of chemical compounds on the cardiovascular system

The main tasks in epidemiological and experimental study of remote effects on the cardiovascular system of exposure to chemical compounds were formulated. In the epidemiological respect, the most important points are development of methods for integral evaluation of the effect of the environment, including the industrial environment, and improvement of the methods of detecting early signs of cardiovascular pathology closely correlating with the structure of cardiovascular morbidity and mortality. The most topical experimental problem is to refine the criteria and methods of assessing the state of the heart and vessels of experimental animals so as to make possible a substantiated and adequate extrapolation of experimental data to man.     

Molecular and cellular alterations in tobacco smoke-associated larynx cancer

Tumours of head and neck belong to the most frequent types of cancer world-wide. In Poland, mortality from larynx cancer among males has been continuously increasing during the last decades up to 8.4 deaths per 100,000 men in 1993, which exceeds epidemiological records from other countries. The aetiology of laryngeal cancer is strongly associated with exposure to carcinogens present in tobacco smoke. The review describes a sequence of molecular and cellular events from carcinogenic exposure, DNA adduct formation, detection of mutations in the p53 gene, loss of heterozygosity (LOH) in chromosomal loci encoding the p53 and p16 genes, and loss of control of the cell cycle. The section concerning DNA adducts includes a discussion of the role of such confounders as exogenous exposure, the age and sex of the subject, and disease progression. The significance of genetic factors as individual risk determinants is discussed in relation to bleomycin-induced chromosome instability and in connection with the occurrence of defects in genes encoding detoxifying enzymes. The question concerning the substantial difference between men and women in larynx cancer morbidity and mortality remains open, even when the significantly higher adduct formation in male DNA compared with female material was taken into account. Preliminary experiments suggest a role of the frequently observed loss of the Y-chromosome.     

Updated Mortality Analyses of Pernis Epidemiological Data on Human Exposures to Aldrin and Dieldrin

An extensive clinical and epidemiological study of workers engaged in the manufacturing and formulation of aldrin and dieldrin, the Pernis study, provides occupational hygiene and biological monitoring data on individual exposures over the years of employment and provides the opportunity to investigate dose response relationships for these chemicals. The human epide miological mortality data on these workers, who were exposed to fairly substan tial lifetime average daily doses of aldrin and dieldrin, suggest that low dose exposures do not significantly increase human mortality and may even de crease the human mortality hazard rate. While hormesis from low dose expo sure to aldrin and dieldrin is not statistically significant, it is observed in the raw data and in the best fitting dose response models. The decrease in risk suggests increased survival time at low doses of aldrin and dieldrin. Using an upper bound on cancer potency based on mouse liver tumors, the U.S. Environmental Protection Agency (EPA) estimated that lifetime average daily doses (LADDs) of 0.0000625 and 0.00625?µg/kg body weight/day would correspond to increased cancer risks of 0.000001 and 0.0001, respectively. However, the best estimate from the Pernis epidemiological data is that LADDs of 0.0000625 and 0.00625?µg/kg body weight/day correspond to no increase in cancer risk and a decrease in the probability of mortality from all causes by the age of 70 years. At low doses of aldrin and dieldrin, the estimated decrease in mortality in a reference period of 70 years is more than 1000 times larger than the U.S. EPA's upper bound on the increase in the lifetime probability of cancer.     

Calculation of the morbid risk in genetic-epidemiologic studies of age-dependent diseases

Distributions of age at onset are widely used in the genetic epidemiology of age-dependent diseases. Examples are estimation of recurrent risks in genetic counselling and testing genetic hypotheses in segregation and linkage analyses. In this study, morbidity parameters are defined, including age-specific morbidity rates, morbidity net risk (incidence), and cumulative incidence (population risk, an integrated measure of population susceptibility to the disease at the moment of the study). Age-specific morbidity risks are calculated from the respective morbidity rates, which are analogous to mortality rates used in demography. Population data typically used for calculation of morbidity rates are discussed. Methods of calculation of morbidity rates based on the data of single and interval epidemiological studies are described. Methods for calculating standard errors of these parameters, estimating their statistical reliability, and testing statistical hypotheses are discussed.     

GDF-15 for Prognostication of Cardiovascular and Cancer Morbidity and Mortality in Men

The objective was to evaluate the hypothesis that growth-differentiation factor 15 (GDF-15) is an independent marker of the long-term risk for both cardiovascular disease and cancer morbidity beyond clinical and biochemical risk factors. Plasma obtained at age 71 was available from 940 subjects in the Uppsala Longitudinal Study of Adult Men (ULSAM) cohort. Complete mortality and morbidity data were obtained from public registries. At baseline there were independent associations between GDF-15 and current smoking, diabetes mellitus, biomarkers of cardiac (high-sensitivity troponin-T, NT-proBNP) and renal dysfunction (cystatin-C) and inflammatory activity (C-reactive protein), and previous cardiovascular disease (CVD). During 10 years follow-up there occurred 265 and 131 deaths, 115 and 46 cardiovascular deaths, and 185 and 86 events with coronary heart disease mortality or morbidity in the respective total cohort (n=940) and non-CVD (n=561) cohort. After adjustment for conventional cardiovascular risk factors, one SD increase in log GDF-15 were, in the respective total and non-CVD populations, associated with 48% (95%CI 26 to 73%, p<0.001) and 67% (95%CI 28 to 217%, p<0.001) incremental risk of cardiovascular mortality, 48% (95%CI 33 to 67%, p<0.001) and 61% (95%CI 38 to 89%, p<0.001) of total mortality and 36% (95%CI 19 to 56%, p<0.001) and 44% (95%CI 17 to 76%, p<0.001) of coronary heart disease morbidity and mortality. The corresponding incremental increase for cancer mortality in the respective total and non-cancer disease (n=882) population was 46% (95%CI 21 to 77%, p<0.001) and 38% (95%CI 12 to 70%, p<0.001) and for cancer morbidity and mortality in patients without previous cancer disease 30% (95%CI 12 to 51%, p<0.001). In conclusion, in elderly men, GDF-15 improves prognostication of both cardiovascular, cancer mortality and morbidity beyond established risk factors and biomarkers of cardiac, renal dysfunction and inflammation.     

Epidemiological analysis of testicular malignant neoplasm incidence and mortality in Poland 1963-1986

Epidemiological analysis of both morbidity and mortality rates for testicular cancer in Poland between 1963 and 1986 was carried out. A particular attention was drawn to the period between 1981 and 1986, when a program of combined chemotherapy and surgery was introduced in Poland. The study aimed at analysing an effect of this combined treatment on mortality rate for testicular cancer. Between 1963 and 1986, a constant increase in morbidity for the testicular cancer was noted. Mortality rate increased between 1963 and 1983. This trend was inhibited between 1984 and 1986. "Splitting" of the morbidity and mortality curves was observed between 1984 and 1986. A decrease in mortality rate was noted at the constant morbidity for testicular tumors. It was particularly clear in younger age groups (15-39 years), as well as older age groups (60-64 years and over 75 years). A decrease in mortality rate for testicular tumors within 1984-1986 may be attributed to the introduction of combined treatment in Poland.     

Historical and life course timing of the male mortality disadvantage in Europe: epidemiologic transitions, evolution, and behavior

This study employs vital statistics data from Sweden, England, Wales, France, and Spain to examine male:female mortality differentials from 1750 through 2000 and their interrelationship with epidemiological transitions. Across all ages and time periods, the largest relative mortality disadvantages are to young adult men. When crisis mortality from the two world wars is removed, we show that the mortality in this young male age group is about two to three times the level of female mortality across all countries sampled. In addition, we show that the timing of this stabilization in male mortality disadvantages occurs during the last half of the twentieth century, at the same point that our measure of epidemiological change also stabilizes at a new low level. The findings are consistent with an interdisciplinary theoretical model that links social, technological and epidemiological changes that occurred through the first half of the 20th century with the unmasking and accentuation of mortality disadvantages among young adult men.