Changes in lung‐cancer mortality trends in Spain

Abstract

Several changes in smoking patterns over the past decades in Spain can be expected to result in a shift in lung-cancer mortality rates. We examined time trends in lung-cancer mortality from 1973-1997 using a log-linear Poisson ageperiod-cohort model. The standardized lung-cancer mortality rate for men almost doubled, from 31.4 per 100,000 in 1973 to 58.6 in 1997, with an average annual increase of 2.7%. Mortality increased for male generations born until 1952 as a consequence of the increasing cigarette smoking in successive birth cohorts. However, the slight downward trend observed for the 2 youngest generations suggests a more favorable outcome of the lung-cancer epidemic among Spanish males in the coming years, if this trend continues. For women, mortality rates were 5 to 9 times lower than those for men, 6.3 per 100,000 in 1973 and 6.4 in 1997. However, the increasing mortality among younger generations born since 1942 reflects the rise in the prevalence of smoking women during the last decades and can be expected to spread to older age groups as a cohort effect, indicating the early phase of the smoking-related lung-cancer epidemic among Spanish females. The decreasing mortality trend observed in women until the late 1980s could be attributed to a lower exposure to environmental tobacco smoke at home as a result of a significant reduction in the prevalence of smoking men. In Mediterranean countries and in Spain since 1990, malignant tumors are the leading cause of death, whereas heart diseases are placed second. 1 Lung cancer is the most frequent fatal cancer among men in Spain 2 as well as in many other developed countries.Because of the poor survival from lung cancer, there is a close correlation between incidence and mortality. The overall 5-year survival rate of 10 -13% has not changed over the past 2 decades, though the implementation of multimodality therapy in locally advanced disease has begun to modestly improve survival in patients with more advanced stages of disease. 3 Cigarette smoking plays a dominant role in lung-cancer causation, being responsible for up to 90% of the lung-cancer epidemic, not only directly but indirectly (passive smoking) and in association with other substances such as asbestos and radon. 4 Smoking patterns have changed markedly and in different directions in several countries over the past decades; therefore, time trends in lung-cancer mortality differ between countries, cohorts and sexes. 5 Several changes in smoking habits in Spain, such as a decline in the prevalence of smoking among men and a rise among women, can be expected to result in a shift in lung-cancer mortality trends.Because tobacco smoking habits are generally established at an early age and are characteristic for a given birth cohort, 5 the development of the lung-cancer epidemic can be analyzed most accurately by studying age-specific rates by birth cohort. 6 We analyzed trends in lung-cancer mortality in Spain from 1973-1997, using a Poisson log-linear age-period-cohort model. MATERIAL AND METHODSPopula...

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