Gastric Cancer Mortality Trends in the Southern Cone: Disentangling age, period and cohort patterns in Argentina and Chile

Abstract

Although Argentina and Chile are neighboring countries, gastric cancer (GC) is the first cancer death cause in the Chilean male population, while it is ranked in fifth place for Argentinean males. This study is the first to identify the differential time-patterns associated with the age-period-cohort effects for the last few decades (1990-2015) in these Southern Cone countries. Trends of age-standardized truncated mortality rates (ASMR) for GC were analyzed using log-linear Poisson age-period-cohort models, including cubic splines for each component. The ASMR trends for GC decreased in both sexes but more considerably in Chile and more favorably for males (annual percentage changes 2002-2015 = −3.5, 95%CI: −3.9 to −3.1). Moreover, GC age-specific mortality rates were noticeably higher in Chile. A favorable decreasing mortality risk throughout the periods (from 2000) and by cohort was observed for both countries; however, the risk reduction has stabilized in younger female cohorts since 1950-cohort. In conclusion, overall favorable decreasing trends for GC mortality were found; however, when ageperiod-cohort effects were disentangled, Chile and younger female cohorts showed a more unfavorable scenario. Obesity, lifestyles, and environmental conditions (like altitude) may explain country differences. This analytical approach may be a valuable tool to be replicated in other countries with no population-based cancer registries and acceptable mortality data quality. Gastric cancer (GC) is one of the five most frequent cancers (excluding non-melanoma skin cancer) in the world 1,2 and the third leading cause of cancer death in both sexes worldwide 1. Although GC mortality rates have been declining over the last few decades, the rates in several countries in South America and Asia remain the highest in the world 3. The number of deaths in Latin America and the Caribbean attributable to this cancer is among the highest in the world; South America is the third region with one of the highest age-standardized (World Standard Population) incidence rates for GC, preceded only by Eastern Asia and Central and Eastern Europe 1. Characteristics of the Southern Cone that distinguish it from the northern area of South America include unusually high consumption of meat, mainly barbecued, and wine consumption, which has already been reported as associated with cancer 4. However, Chile and Argentina are among the countries in South America with the highest and lowest age-standardized mortality rates (ASMR) for both sexes, respectively (ranked in third and 23th place among the 32 countries in the region), with overall ASMR equals of 17.9 and 6.4 per 100,000 in men and women for Chile, and 7.5 and 3.0 for Argentina, respectively 5. Thus, even though they are neighboring countries in the Southern Cone with similar reports of the human development index and behaviors, the health differences between these countries should be analyzed. Helicobacter pylori (H. pylori) infection is a primary risk factor of GC. It is estimated that about half o...

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