F. Lucchini

Trends in mortality from cardiovascular and cerebrovascular diseases in Europe and other areas of the world

Objective: To analyse trends in mortality from coronary heart disease (CHD) and cerebrovascular disease (CVD) over the period 1965 to 1998 in the European Union, other European countries, the USA, and Japan. Methods and results: Data were derived from the World Health Organization database. In the European Union, CHD mortality in men rose from 146/100 000 in 1965–9 to 163/100 000 in 1975–9 and declined thereafter to 99/100 000 in 1995–8 (−39%). In women, the fall was from 70 to 45/100 000 (−36%). A > 55% decline in CVD was registered in both sexes. In eastern Europe, mortality from both CHD and CVD rose up to the early 1990s but has declined over the past few years in Poland and the Czech Republic. In the Russian Federation during 1995–8, mortality rates from CHD reached 330/100 000 men and 154/100 000 women and mortality rates from CVD were 203/100 000 men and 150/100 000 women—that is, they were among the highest rates worldwide. In the USA and Japan, long term trends were favourable for both CHD and CVD. Conclusions: Trends in mortality from CHD and CVD were favourable in several developed areas of the world, but there were major geographical differences. In a few eastern European countries, mortality from CHD and CVD remains exceedingly high.

Food groups and colorectal cancer risk

SummaryMost studies of diet and colorectal cancer have considered nutrients and micronutrients, but the role of foods or food groups remains open to debate. To elucidate the issue, we examined data from a case–control study conducted between 1992 and 1997 in the Swiss canton of Vaud. Cases were 223 patients (142 men, 81 women) with incident, histologically confirmed colon (n = 119) or rectal (n = 104) cancer (median age 63 years), linked with the Cancer Registry of the Swiss Canton of Vaud, and controls were 491 subjects (211 men, 280 women, median age 58 years) admitted to the same university hospital for a wide spectrum of acute non-neoplastic conditions unrelated to long-term modifications of diet. Odds ratios (OR) were obtained after allowance for age, sex, education, smoking, alcohol, body mass index, physical activity and total energy intake. Significant associations were observed for refined grain (OR = 1.32 for an increase of one serving per day), and red meat (OR = 1.54), pork and processed meat (OR = 1.27), alcohol (OR = 1.28), and significant protections for whole grain (OR = 0.85), raw (OR = 0.85) and cooked vegetables (OR = 0.69), citrus (OR = 0.86) and other fruits (OR = 0.85), and for coffee (OR = 0.73). Garlic was also protective (OR = 0.32 for the highest tertile of intake). These findings in a central European population support the hypothesis that a diet rich in refined grains and red meat increases the risk of colorectal cancer; they, therefore, support the recommendation to substitute whole grains for refined grain, to limit meat intake, and to increase fruit and vegetable consumption.

Mortality from cardiovascular and cerebrovascular diseases in Europe and other areas of the world: an update

Objective To update trends in mortality from coronary heart diseases (CHD) and cerebrovascular diseases (CVD) over the period 1981-2004 in Europe, the USA, Latin America, Japan and other selected areas of the world. Methods Age-standardized mortality rates were derived from the World Health Organization database. Joinpoint analysis was used to identify significant changes in trends. Results In the European Union (27 countries), CHD mortality in men declined from 139/100 000 in 1985-1989 to 93/100 000 in 2000-2004 (−33%). In women, the fall was from 61/100 000 to 44/100 000 (−27%). In this area, a decline by over 30% was also registered in CVD mortality for both sexes. In the Russian Federation and other countries of the former Soviet Union, CHD rates in 2000-2004 were exceedingly high, around 380/100 000 men and 170/100 000 women in Russia, 430 for men and 240 for women in Ukraine, 420 and 200 in Belarus. For CVD, a similar situation was registered, with mortality rates of 226/100 000 for men and 159/100 000 for women in 2004 in the Russian Federation, and more than 24% increase since the late 1980s for men and 15% for women. CHD and CVD mortality continued to decline in most Latin American countries, Australia and other areas considered, including Asia (even if with marked differences). Conclusion Although mortality from CHD and CVD continues to decline in several areas of the world including most countries of Europe and of the America providing data and Australia, unfavourable trends were still observed in the Russian Federation and other countries of the former Soviet Union, whose recent rates remain exceedingly high.

Cancer mortality in the European Union, 1970–2003, with a joinpoint analysis

BACKGROUND Cancer mortality peaked in the European Union (EU) in the late 1980s and declined thereafter. MATERIALS AND METHODS We analyzed EU cancer mortality data provided by the World Health Organization in 1970-2003, using join point analysis. RESULTS Overall, cancer mortality levelled off in men since 1988 and declined in 1993-2003 (annual percent change, APC = -1.3%). In women, a steady decline has been observed since the early 1970s. The decline in male cancer mortality has been driven by lung cancer, which levelled off since the late 1980s and declined thereafter (APC = 2.7% in 1997-2003). Recent decreases were also observed for other tobacco-related cancers, as oral cavity/pharynx, esophagus, larynx and bladder, as well as for colorectal (APC = -0.9% in 1992-2003) and prostate cancers (APC = -1.0% in 1994-2003). In women, breast cancer mortality levelled off since the early 1990s and declined thereafter (APC = -1.0% in 1998-2003). Female mortality declined through the period 1970-2003 for colorectal and uterine cancer, while it increased over the last three decades for lung cancer (APC = 4.6% in 2001-2003). In both sexes, mortality declined in 1970-2003 for stomach cancer and for a few cancers amenable to treatment. CONCLUSION This update analysis of the mortality from cancer in the EU shows favorable patterns over recent years in both sexes.

Cancer mortality in Europe, 1990–1994, and an overview of trends from 1955 to 1994

Mortality data, abstracted from the WHO database, are presented in tabular form for 26 cancer sites or groups of sites, plus total cancer mortality, in 35 European countries during the period 1990-1994. Trends in mortality are also given in graphical form for 24 major countries over the period 1955-1994. In most western European countries total cancer mortality was--for the first time--moderately downwards in the early 1990s. Such favourable trends included some decline in lung cancer mortality for males, the persistent decline in stomach cancer for both sexes, and of cervical cancer for women, as well as some decline in breast and colorectal cancers, plus other neoplasms (testis, lymphoid neoplasms), whose treatment has further improved over the last few years. However, cancer mortality was still upwards in a few southern and eastern European countries, including Hungary and Poland, where total cancer mortality rates in middle-aged males are now the highest ever registered in Europe. The favourable trends in western Europe over the recent years are similar to those observed in the U.S.A.

Cervical cancer mortality in young women in Europe: patterns and trends

On the basis of overall national death certification data, it is not possible to analyse mortality from cervical cancer in Europe, since 20-65% of deaths from uterine cancer in largest countries are still certified as uterus, unspecified. We analysed, therefore, age-standardised death certification rates from uterine cancer between 1960 and 1998 in women aged 20-44 years, since most deaths from uterine cancer below the age of 45 years arise from the cervix. In all Western European countries, except Ireland, substantial declines in cervical cancer mortality in younger women were observed, although the falls were larger and earlier for some Nordic countries. The trends were irregular in the UK, with earlier declines between 1960 and 1970, followed by a rise between 1970 and 1985, and a subsequent fall. In Ireland, mortality from uterine cancer at age 20 to 44 years has been rising since the early 1980s, to reach 3.4/100000 in 1995-1996. In Eastern Europe, some fall in mortality was observed in Hungary and Poland, while trends were upwards in Romania since 1980, and in Bulgaria. In all these countries, moreover, absolute rates remained appreciably higher than in most of Western Europe, and in the late 1990s there was over a 10-fold variation between the highest rates in Romania (10.6/100000 women aged 20-44 years) and the lowest ones in Finland (0.5/100000) or Sweden (0.9/100000). Within the European Union, the variation was over 6-fold, the highest rates being registered in Ireland (3. 4/100000) and Portugal (3.2/100000). The declines registered in cervical cancer mortality in young women were largely due to screening, and the persisting variations in mortality across Europe underline the importance of the adoption of organised screening programmes, with specific urgency in Eastern Europe.

Worldwide trends in suicide mortality, 1955–1989

Patterns and trends in suicide mortality for the period 1955–89 for 57 countries (28 from Europe, the former Soviet Union, Canada, the United States, 14 Latin American countries, 8 from Asia and 2 from Africa, Australia and Oceania) were analyzed on the basis of official death certification data included in the World Health Organization mortality database. Over the most recent calendar quinquennium (1985–1989), Hungary had the highest rate for men (52.1 per 100,000, all ages, world standard), followed by Sri Lanka (49.6), Finland (37.2) and a number of central European countries. North America, Japan, Australia and New Zealand and several European countries had intermediate suicide rates (between 15 and 25 per 100,000), whereas overall mortality from suicide was low in the United Kingdom, southern Europe, Latin America and reporting countries and areas from Africa and Asia, except Japan, Singapore and Hong Kong. The pattern for women was similar, although the absolute values were considerably lower. The highest values were in Sri Lanka (19.0 per 100,000), followed by Hungary (17.6) and several other central European countries, with rates between 9 and 15 per 100,000. Female suicide rates were comparatively elevated in Japan, Hong Kong, Singapore and Cuba. With respect to trends over time, the figures were relatively favourable in less developed areas of the world, including Latin America and several countries from Asia, with the major exception of Sri Lanka. Of concern are, in contrast, the upward trends, particularly for elderly men in Canada, the United States, Australia and New Zealand and, mostly, the substantial rises over most recent decades of suicide rates in young cohorts of males in Japan and several European countries, Australia and New Zealand. These trends were often in contrast with more favourable patterns in women, and can be discussed in terms of ethnic, cultural and socioeconomic factors, aspects of psychiatric care or availability of instruments and methods of suicide.

Trends in mortality from primary liver cancer in Europe

Upward trends in incidence and mortality from primary liver cancer have been reported from Japan, the USA and a few European countries. Thus, we systematically reviewed trends in age-standardised death certification rates from primary liver cancer between 1970 and 1996 in 20 European countries providing data for the World Health Organisation database. Overall age-standardised (world population) mortality rates were approximately stable or showed no consistent trends in seven countries, including Bulgaria and Hungary (with exceedingly high rates), Finland, The Netherlands and the UK. Moderate rises were observed in Austria, Germany and Switzerland, and much larger upward trends in France and Italy, particularly for males. Downward trends were observed in both sexes in Belgium, Spain, Ireland, Greece and several Scandinavian countries. The per cent change in rates per year ranged, for males, from -7.4% for Ireland and -5.1% for Spain to +4.4% for Italy and +8.6% for France. Trends were more favourable in women, with 15 out of 20 countries showing downward trends in rates, and moderately more favourable in middle age (45-64 years) and, in major European countries, in young adults (20-44 years of age). In conclusion, trends in liver cancer mortality in Europe are heterogeneous. The fall in mortality in countries like Spain may be largely explained by improvements in the distinction between primary and secondary liver neoplasms, whereas upward trends in Central Europe and Italy are likely to be, at least in part, real. Increases in infection with the hepatitis C virus, and improved and increased searches for liver cancer in cirrhotic patients are two of the likeliest explanations for these observations.

Resveratrol and breast cancer risk.

Resveratrol is a non-flavonoid polyphenol that has attracted attention as a potential anticancer agent in vitro and in vivo, but scanty epidemiological data are available. We have therefore analysed the relation between dietary intake of resveratrol and breast cancer risk using data from a case–control study conducted between 1993 and 2003 in the Swiss Canton of Vaud on 369 cases and 602 controls. Compared with the lowest tertile of total resveratrol intake, the multivariate odds ratios (OR) were 0.50 for the intermediate and 0.39 for the highest tertile, and the trend in risk was significant. A significant inverse association was observed for resveratrol from grapes (OR = 0.64 and 0.55), but not for wine. The inverse relation between resveratrol and breast cancer risk was not explained by several potential confounding factors, including detailed allowance for alcohol intake, nor attributable to a non-specific favourable effect of fruit on breast cancer risk.

Selected micronutrients and colorectal cancer. a case-control study from the canton of Vaud, Switzerland.

The association between dietary intake of various micronutrients and colorectal cancer risk was analysed using data from a case-control study conducted between 1992 and 1997 in the Swiss Canton of Vaud. Cases were 223 subjects (142 (64%) males, 81 (36%) females; median age 63 years) with incident, histologically confirmed colon (n=119; 53%) or rectal (n=104; 47%) cancer, and controls were 491 subjects (211 (43%) males, 280 (57%) females; median age 58 years; range 27-74) admitted to the same university hospital for a wide spectrum of acute non-neoplastic conditions, unrelated to long-term modifications of diet. Dietary habits were investigated using a validated food frequency questionnaire (FFQ). Odds ratios (OR) were obtained after allowance for age, sex, education, smoking, alcohol, body mass index, physical activity, and total energy and fibre intake. No significant association was observed for calcium, retinol, folate, vitamin D or E. The risk of colorectal cancer was directly associated with measures of iron intake (OR=2.43 for the highest tertile, 95% confidence interval (CI): 1.2-5.1) and inversely associated with vitamin C (OR=0.45; 95% CI: 0.3-0.8), and non-significantly with total carotenoids (OR=0.66, 95% CI: 0.4-1.1). Among various individual carotenoids considered, inverse associations were observed for alpha-carotene, beta-carotene and lutein/zeaxanthin. These findings were consistent across the strata of gender and age, and support the hypothesis that selected micronutrients have a favourable effect on colorectal carcinogenesis.