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Archives of Public Health

, 67:100

First Online: 27 November 2009DOI: 10.1186-0778-7367-67-3-100

Cite this article as: Raifu, A. & Arbyn, M. Arch Public Health 2009 67: 100. doi:10.1186-0778-7367-67-3-100

Abstract

ObjectiveTo correct cervical cancer mortality rates for death cause certification problems in Belgium and to describe the corrected trends 1954-1997 using Bayesian models.

MethodCervical cancer cervix uteri CVX, corpus uteri CRP, not otherwise specified NOS uterus cancer and other very rare uterus cancer OTH mortality data were extracted from the WHO mortality database together with population data for Belgium and the Netherlands.

Different ICD International Classification of Diseases were used over time for death cause certification. In the Netherlands, the proportion of not-otherwise specified uterine cancer deaths was small over large periods and therefore internal reallocation could be used to estimate the corrected rates cervical cancer mortality. In Belgium, the proportion of improperly defined uterus deaths was high. Therefore, the age-specific proportions of uterus cancer deaths that are probably of cervical origin for the Netherlands was applied to Belgian uterus cancer deaths to estimate the corrected number of cervix cancer deaths corCVX.

A Bayesian loglinear Poisson-regression model was performed to disentangle the separate effects of age, period and cohort.

ResultsThe corrected age standardized mortality rate ASMR decreased regularly from 9.2-100 000 in the mid 1950s to 2.5-100,000 in the late 1990s. Inclusion of age, period and cohort into the models were required to obtain an adequate fit. Cervical cancer mortality increases with age, declines over calendar period and varied irregularly by cohort.

ConclusionMortality increased with ageing and declined over time in most age-groups, but varied irregularly by birth cohort. In global, with some discrete exceptions, mortality decreased for successive generations up to the cohorts born in the 1930s. This decline stopped for cohorts born in the 1940s and thereafter. For the youngest cohorts, even a tendency of increasing risk of dying from cervical cancer could be observed, reflecting increased exposure to risk factors. The fact that this increase was limited for the youngest cohorts could be explained as an effect of screening.

Bayesian modeling provided similar results compared to previously used classical Poisson models. However, Bayesian models are more robust for estimating rates when data are sparse youngest age groups, most recent cohorts and can be used to for predicting future trends.

KeywordsCervical cancer trend analysis mortality Bayesian analysis age-cohort-period modelling  Download fulltext PDF



Autor: AO Raifu - M Arbyn

Fuente: https://link.springer.com/



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