RESUMEN
OBJECTIVE: An ecologic study on the level of districts was performed to evaluate the possible association between district type and risk of cancer in Bavaria, Southern Germany. METHODS: Cancer incidence data for the years 2003-2012 were obtained from the population-based cancer registry Bavaria according to sex and cancer site. Data on district type, socio-economic area deprivation, particulate matter exposure, tobacco consumption, and alcohol consumption were obtained from publicly available sources. The possible association between district type and cancer risk adjusted for age, socio-economic area deprivation, particulate matter exposure, tobacco consumption, and alcohol consumption was evaluated using multivariable multi-level negative binomial regression. RESULTS: We found a significantly reduced cancer risk in densely populated districts close to core cities and/or rural districts compared to core cities with respect to the cancer sites mouth and pharynx (women only), liver (both sexes), larynx (both sexes), lung (both sexes), melanoma of the skin (both sexes), mesothelioma (men only), connective and soft tissue (both sexes), corpus uteri, other urinary tract (men only), urinary bladder (both sexes), and non-Hodgkin lymphoma (both sexes). CONCLUSION: Our findings require further monitoring. Since the apparently increased cancer risk in core cities may be related to lifestyle factors, preventive measures against lifestyle-related cancer could be specifically targeted at populations in deprived core cities.
Asunto(s)
Ciudades/estadística & datos numéricos , Neoplasias/epidemiología , Población Rural/estadística & datos numéricos , Población Urbana/estadística & datos numéricos , Distribución por Edad , Anciano , Consumo de Bebidas Alcohólicas/epidemiología , Exposición a Riesgos Ambientales/estadística & datos numéricos , Femenino , Alemania/epidemiología , Humanos , Incidencia , Estilo de Vida , Masculino , Persona de Mediana Edad , Material Particulado , Sistema de Registros , Características de la Residencia , Factores de Riesgo , Distribución por Sexo , Fumar/epidemiología , Factores SocioeconómicosRESUMEN
In this module, we have discussed study designs that have not been covered in the previous modules - ecologic studies and natural experiments. In an ecologic study, the unit of analysis is a group or aggregate rather than the individual. It may be the characteristics of districts, states, or countries. For example, per capita income across countries, income quintiles across districts, and proportion of college graduates in states. If the data already exist (such as global measures and prevalence of diseases, data sets such as the National Family Health Survey, census data), then ecologic studies are cheap and data are easy to collect. However, one needs to be aware of the "ecologic fallacy." The researcher should not interpret ecologic level results at the individual level. In "natural experiments," the researcher does not assign the exposure (as is the case in interventional studies) to the groups in the study. The exposure is assigned by a natural process. This may be due to existing policies or services (example, one city has laws against specific vehicles and the other city does not); changes in services or policies; or introduction of new laws (such helmet for bikers and seat-belts for cars). We would like to encourage researchers to explore the possibility of using these study designs to conduct studies.
RESUMEN
O câncer de colo do útero ainda é uma das neoplasias malignas mais frequentes no mundo, particularmente em países subdesenvolvidos, que abrigam grande número dos casos e mortes em decorrência dessa neoplasia, a despeito de sua detecção em fase incipiente e tratável ser possível com o teste de Papanicolau. O objetivo deste trabalho é descrever a tendência da taxa de mortalidade por câncer de colo do útero na cidade de Salvador e no estado da Bahia de 1980 a 2007. Trata-se de estudo de agregados cujos dados sobre os óbitos e sobre a população foram obtidos no SIM/Datasus e no IBGE/Datasus, respectivamente. Calcularam-se as taxas de mortalidade padronizadas por idade e razões entre essas taxas, cujos resultados significam redução ou incremento percentual médio anual, ajustadas pelo número de óbitos por causa mal definida. Para a análise da tendência temporal, utilizou-se a regressão de Poisson, com avaliação de superdispersão. Os resultados apontam, em Salvador, redução da anual média da taxa de mortalidade (menos 2,14por cento) e tendência decrescente em todas as faixas etárias. A Bahia apresentou um discreto aumento médio anual da taxa de mortalidade (mais 0,17por cento). Conclui-se que se necessita de ações de prevenção, diagnóstico e tratamento do câncer cervical em Salvador e, particularmente, no interior da Bahia.
The cervical cancer is one of the most frequent malignant neoplasms all over the world, particularly in undeveloped countries, which have a large number of cases and deaths, despite of the possibility of early detection by Papanicolau test and effective treatment. The goals of this study are to describe the mortality trends of cervical cancer in the State of Bahia and in the city of Salvador from 1980 to 2007. This is an aggregate study based on death and population data collected in the Mortality Information System ? SIM/DATASUS/Ministry of Health and in IBGE/DATASUS, respectively. There were calculated standardized mortality rates by age and mortality rate ratios, which mean an average annual increasing or decreasing, adjusted by deaths due to undefined causes. Poisson regression models were used to analyze the temporal trends, with evaluation of over dispersion. In Salvador there was a reduction of average annual mortality rate (less 2.14percent) and there was a decreasing trend in all age groups. In the state of Bahia there was a slight increase on the average annual mortality rate (more 0.17percent). In conclusion, there is still much to be done regarding prevention, diagnosis and treatment of cervical cancer in Salvador, and particularly in the countryside of Bahia.
El cáncer de cuello uterino es, aún, una de las neoplasias malignas más frecuentes en el mundo, particularmente en los países en desarrollo, que contemplan una gran cantidad de casos y muertes por este tumor, a pesar de su detección y posible tratamiento en una etapa temprana con la prueba de Papanicolaou. El objetivo de este estudio es describir la tendencia de mortalidad por cáncer de cuello uterino, de 1980 a 2007, en la ciudad de Salvador y en el Estado de la Bahía. Se trata de un estudio de agregados cuya recolecta de datos sobre óbitos y población fueron recogidos, respectivamente, en el Sistema de Informaciones sobre Mortalidad - SIM / DATASUS / Ministerio de Salud y en el IBGE / DATASUS. Han sido calculadas las tasas de mortalidad estandarizadas por edad y razones entre estas tasas, cuyos resultados demuestran 724 reducción o aumento del promedio anual, ajustado por el número de muertes debido a causas no definidas. Para analizar las tendencias temporales se utilizó el modelo de regresión de Poisson, con evaluación de la sobre dispersión. Los resultados indican que, en Salvador, hubo una reducción media anual de la tasa de mortalidad (menos 2,14 por ciento) y una tendencia a la baja en todos los grupos de edad. El estado de la Bahía presentó un ligero aumento medio anual de la tasa de mortalidad (más 0,17por ciento). Se concluye que existe la necesidad de acciones de prevención, diagnóstico y tratamiento del cáncer de cuello uterino en Salvador y, en particular, en el interior de la Bahía.