Teresa Rodriguez

Trends in mortality from coronary heart and cerebrovascular diseases in the Americas: 1970–2000

Objective: To describe trends in mortality from coronary heart disease (CHD) and cerebrovascular accidents (CVAs) over the period 1970 to 2000 in the Americas. Methods: Age standardised mortality rates were derived from the World Health Organization database and grouped according to the International classification of diseases, ninth revision. Joinpoint analysis was used to identify changes in trends. Results: In the USA and Canada, CHD mortality rates declined by about 60% in both sexes. In Latin America, falls in CHD mortality were observed for Argentina, Brazil, Chile, Cuba, and Puerto Rico. In 2000, mortality rates among men were highest in Venezuela (137.3/100 000) and lowest (apart from Ecuador) in Argentina (63.5/100 000). For women, the rates were highest in Cuba (79.4/100 000) and lowest in Argentina (26.5/100 000). For CVA mortality, a decline by about 60% was observed in the USA and Canada for both sexes. The falls were smaller (about −25% to −40% among men and −20% to −50% among women) in Puerto Rico, Argentina, Chile, and Costa Rica and only minor in Ecuador, Mexico, and Venezuela. Around 2000, CVA mortality in Latin America was highest in Brazil (85.5/100 000 among men and 61.7/100 000 among women) and lowest in Puerto Rico (29.3/100 000 among men and 24.1/100 000 among women). Conclusions: Recent falls in CHD and CVA were less favourable in Latin America than in the USA and Canada. This may reflect unfavourable changes in nutrition (including obesity), physical activity, and smoking in most Latin American countries, together with less effective control of hypertension and management of the diseases.

Global trends and predictions in hepatocellular carcinoma mortality

BACKGROUND & AIMS Trends in hepatocellular carcinoma (HCC) mortality rates have increased over recent decades in most countries. It is also the third cause of cancer death worldwide. The aim of this study is to update global trends in HCC mortality to 2014, and predict trends in rates in the EU, USA and Japan to 2020. METHODS Death certification data for HCC over the 1990-2014 period from the World Health Organization database were analyzed. Sixteen European, five American countries, and six other countries worldwide were included, as well as the EU as a whole. RESULTS In European men, mortality rates were stable during the last decade (3.5/100,000). HCC mortality increased in Northern and Central Europe, and decreased in Southern Europe. In the USA, HCC mortality increased by 35% between 2002 and 2012, reaching 3.1/100,000 men in 2012; it is predicted to remain stable to 2020. Reduced mortality rates were observed in East Asia, although they remained around 10-24/100,000 men. In Japan, HCC mortality is predicted to decrease (5.4/100,000 men in 2020). Trends were favorable in the young, but unfavorable in middle aged, except in East Asia. Mortality rates were 3- to 5-fold lower in women than men in most regions, but trends were similar. CONCLUSIONS Control of hepatitis B (HBV) and hepatitis C virus (HCV) infections has contributed to the decrease in HCC-related mortality in East Asia and Southern Europe. Unfavorable trends in other regions can be attributed to HCV (and HBV) epidemics in the 1960s and 1980s, alcohol consumption, increased overweight/obesity, and diabetes. Better management of cirrhosis, HCC diagnosis and treatment are also influencing the mortality trends worldwide. LAY SUMMARY Mortality rates due to HCC have increased in many countries over recent decades. In this study, we updated worldwide mortality trends for HCC from 1990 to 2014, and predicted trends for some countries to 2020. We observed unfavorable trends in Northern and Central Europe, North and Latin America. East Asia showed an improvement, however mortality rates in this region were 2- to 5-fold higher than in most European countries and the Americas. Steady declines to 2020 are predicted for East Asia but not for Europe and the Americas.

Hodgkin's lymphoma mortality in the Americas, 1997–2008: Achievements and persistent inadequacies

Although therapeutic advancements have made Hodgkins lymphoma (HL) a largely curable disease, trends in HL mortality have been variable across countries. To provide updated information on HL mortality in the Americas, overall and 20–44 years age‐standardized (world population) mortality rates from HL were derived for the 12 Latin American countries providing valid data to the World Health Organization database and with more than two million of inhabitants. For comparative purpose, data for the United States and Canada were also presented. Trends in mortality over the 1997 to 2008 period are based on joinpoint regression analysis. Declines in HL mortality were registered in all Latin American countries except in Venezuela. In most recent years, HL mortality had fallen to about 0.3/100,000 men and 0.2/100,000 women in Argentina, Brazil, Chile, Colombia, Ecuador and Guatemala, that is, to values similar to North America. Despite some declines, rates remained high in Cuba (1/100,000 men and 0.7/100,000 women), Costa Rica and Mexico as well as in Venezuela (between 0.5 and 0.6/100,000 men and between 0.3 and 0.5/100,000 women). In young adults, trends were more favorable in all Latin American countries except Cuba, whose rates remained exceedingly high (0.8/100,000 men and 0.6/100,000 women). Thus, appreciable declines in HL mortality were observed in most Latin America over the last decade, and several major countries reached values comparable to North America. Substantial excess mortality was still observed in Cuba, Costa Rica, Mexico and Venezuela, calling for urgent interventions to improve HL management in these countries.

Cancer mortality predictions for 2017 in Latin America

Background From most recent available data, we predicted cancer mortality statistics in selected Latin American countries for the year 2017, with focus on lung cancer. Materials and methods We obtained death certification data from the World Health Organization and population data from the Pan American Health Organization database for all neoplasms and selected cancer sites. We derived figures for Argentina, Brazil, Chile, Colombia, Cuba, Mexico and Venezuela. Using a logarithmic Poisson count data joinpoint model, we estimated number of deaths and age-standardized (world population) mortality rates in 2017. Results Total cancer mortality rates are predicted to decline in all countries. The highest mortality rates for 2017 are in Cuba, i.e. 132.3/100 000 men and 93.3/100 000 women. Mexico had the lowest predicted rates, 64.7/100 000 men and 60.6/100 000 women. In contrast, the total number of cancer deaths is expected to rise due to population ageing and growth. Men showed declines in lung cancer trends in all countries and age groups considered, while only Colombian and Mexican women had downward trends. Stomach and (cervix) uteri rates are predicted to continue their declines, though mortality from these neoplasms remains comparatively high. Colorectal, breast and prostate cancer rates were predicted to decline moderately, as well as leukaemias. There was no clear pattern for pancreatic cancer. Between 1990 and 2017 about 420 000 cancer deaths were avoided in 5 of the 7 countries, no progress was observed in Brazil and Cuba. Conclusion Cancer mortality rates for 2017 in seven selected Latin American countries are predicted to decline, though there was appreciable variability across countries. Mortality from major cancers-including lung and prostate-and all cancers remains comparatively high in Cuba, indicating the need for improved prevention and management.

Comparison of Trends in Mortality from Coronary Heart and Cerebrovascular Diseases in North and South America: 1980 to 2013

Until the past century, mortality trends from coronary heart disease (CHD) and cerebrovascular disease (CVD) were less favorable in Latin than in North America. We calculated age-standardized mortality rates using data from the World Health Organization database over the period 1980 to 2013. To identify significant changes in trends, we performed joinpoint analysis. Since the early 2000s, CHD mortality rates decreased by about 35% in the USA and Canada in both genders; similar decreases were observed in some Latin American countries (i.e., Ecuador, Puerto Rico, and Chile), whereas the decreases were smaller in the other countries. In 2011 to 2013, the highest rates were in Venezuela (114.4/100,000 men) and Colombia (86.1/100,000 men) and the lowest ones (apart from Ecuador) in Panama, Chile, and Argentina (from 41 to 46/100,000 men and 18 to 19/100,000 women). For CVD mortality, a decrease by about 30% was observed in Argentina, Panama, and Uruguay plus Colombia for women, in addition to the USA and Canada. Smaller declines were observed in the other Latin American countries (from 23% in Colombian men to 5% in Venezuelan men). Throughout the period, rates in Latin America remained appreciably higher than those in North America. The highest CVD rates were observed in Brazil (51.6/100,000 men) and the lowest ones in Canada (12.9/100,000 women). In conclusion, trends in CHD and CVD mortality continue to be less favorable in Latin America than in Canada and the USA. The marked excess of CVD mortality is partly or largely attributable to inadequate control of dyslipidemia and hypertension.

Trends and predictions to 2020 in breast cancer mortality: Americas and Australasia

OBJECTIVES We considered trends in breast cancer mortality for 12 American and 8 Australasian countries during 1970-2014, and predicted rates for 2020. MATERIALS AND METHODS We obtained official death certification data for breast cancer and population figures from the World Health Organization, Pan American Health Organization and United Nations databases. We derived age-standardized rates (world standard population), and predictions for 2020 using joinpoint regression. RESULTS Breast cancer mortality trends were favourable in North America and Oceania, and a further 10% reduction in their overall rates is predicted for 2020, to reach values of 11-12/100,000 women, i.e. about 50% lower than their top rates in the later 1980s. Hong Kong, Japan and Korea did not show appreciable trends, but their rates remained below 10/100,000. Mexico, Chile, Colombia, Brazil also had stable rates, below or around 10/100,000. Breast cancer mortality was higher in Argentina, Cuba and Venezuela, and only Argentina showed some favourable trends over recent years, and predictions to 2020 around 16/100,000. Trends and predictions were less favourable in Israel, New Zealand, and the Philippines than in most other countries with predicted rates in 2020 between 13 and 16/100,000. CONCLUSION In several high-income countries, the fall in breast cancer mortality, due to improved treatment and diagnosis, has been the major success in the management of any common cancer over the last three decades. There are, however, persistent disparities in the global decline in breast cancer, which call for urgent management improvements in several areas of the world, particularly in middle-income countries.

Efecto de la nueva regulación antitabaco en Italia

OBJETIVO: Se realizo un estudio poblacional para conocer las actitudes relacionadas con la Nueva Ley Italiana Antitabaco y el efecto sobre el consumo. MATERIAL Y METODOS: Se analizo una muestra de 3 114 individuos mayores de 15 anos representativos de la poblacion general adulta italiana. RESULTADOS: Tras la entrada en vigor de las politicas antitabaquismo, el apoyo a ellas aumento y ademas contribuyeron con 8% al descenso del consumo de cigarrillos en el corto plazo. Las prohibiciones antitabaco se aceptaron casi de modo unanime y al parecer no afectaron de manera desfavorable a restaurantes y cafeterias. CONCLUSIONES: Los resultados muestran las ventajas de esta nueva legislacion, que puede tener importantes implicaciones en la salud publica.