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Open Access Research article

Trends in oral cavity, pharyngeal, oesophageal and gastric cancer mortality rates in Spain, 1952–2006: an age-period-cohort analysis

Daniel Seoane-Mato12, Nuria Aragonés23*, Eva Ferreras23, Javier García-Pérez23, Marta Cervantes-Amat23, Pablo Fernández-Navarro23, Roberto Pastor-Barriuso23 and Gonzalo López-Abente23

Author Affiliations

1 Galician Agency for Health Technology Assessment, Galician Health Service, Santiago de Compostela, Spain

2 Cancer and Environmental Epidemiology Area, National Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain

3 CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain

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BMC Cancer 2014, 14:254  doi:10.1186/1471-2407-14-254

Published: 11 April 2014

Abstract

Background

Although oral cavity, pharyngeal, oesophageal and gastric cancers share some risk factors, no comparative analysis of mortality rate trends in these illnesses has been undertaken in Spain. This study aimed to evaluate the independent effects of age, death period and birth cohort on the mortality rates of these tumours.

Methods

Specific and age-adjusted mortality rates by tumour and sex were analysed. Age-period-cohort log-linear models were fitted separately for each tumour and sex, and segmented regression models were used to detect changes in period- and cohort-effect curvatures.

Results

Among men, the period-effect curvatures for oral cavity/pharyngeal and oesophageal cancers displayed a mortality trend that rose until 1995 and then declined. Among women, oral cavity/pharyngeal cancer mortality increased throughout the study period whereas oesophageal cancer mortality decreased after 1970. Stomach cancer mortality decreased in both sexes from 1965 onwards. Lastly, the cohort-effect curvature showed a certain degree of similarity for all three tumours in both sexes, which was greater among oral cavity, pharyngeal and oesophageal cancers, with a change point in evidence, after which risk of death increased in cohorts born from the 1910-1920s onwards and decreased among the 1950–1960 cohorts and successive generations. This latter feature was likewise observed for stomach cancer.

Conclusions

While the similarities of the cohort effects in oral cavity/pharyngeal, oesophageal and gastric tumours support the implication of shared risk factors, the more marked changes in cohort-effect curvature for oral cavity/pharyngeal and oesophageal cancer could be due to the greater influence of some risk factors in their aetiology, such as smoking and alcohol consumption. The increase in oral cavity/pharyngeal cancer mortality in women deserves further study.

Keywords:
Oral and pharyngeal cancer; Oesophageal cancer; Gastric cancer; Mortality; Age-cohort-period analysis; Change-points; Time trends; Spain