Age-period-cohort analysis of lung cancer mortality inequalities in Southern Spain: missed opportunities for implementing equitable tobacco control policies

Changing Patterns of Lung Cancer Mortality in Andalusia: Insights From Age-period-cohort Analysis and Historical Smoking Trends

Introduction

Lung cancer remains one of the leading causes of cancer death worldwide. This study examines lung cancer mortality trends in Andalusia, Spain, from 2003 to 2022, focusing on gender differences and the influence of age, period and cohort effects.

Material and methods

This longitudinal ecological study analyzed lung cancer mortality data in Andalusia from 2003 to 2022, using age-period-cohort (A-P-C) and joinpoint regression models. Mortality rates were calculated by sex, age group, and standardized to the 2013 European Standard Population.

Results

Between 2003 and 2022, Andalusia recorded 68,480 lung cancer deaths, with a significant gender disparity. Male mortality decreased (-1.9%), while female mortality increased (3.5%). Joinpoint analysis revealed a notable rise in female mortality rates after 2015. Age-specific analyses showed decreasing rates for men across all age groups, with a sharper decline for younger men. Women experienced increasing rates, particularly among those aged 35-64. The A-P-C model identified significant cohort effects, with decreasing rate ratios for men and increasing ones for women, reflecting historical smoking patterns.

Conclusions

Lung cancer mortality in Andalusia has exhibited a stark gender divide, reflecting the region's historical smoking patterns. While declining rates among men and younger women indicate the efficacy of tobacco control measures, the persistent rise in female mortality underscores the enduring effects of past smoking habits. These findings emphasize the imperative for ongoing public health initiatives and gender-specific interventions to mitigate the burden of lung cancer in Andalusia.

Is the threat of malignant melanoma in the UK still increasing? A comprehensive analysis of 30 years of historical data and Bayesian age-period-cohort model projections for 2030

Malignant melanoma, a highly aggressive skin cancer, though less common, significantly contributes to cancer-related mortality. In the UK, it is of growing concern with an aging population, making it crucial to analyze historical trends and forecast future burdens. We used Joinpoint regression and age-period-cohort models to analyze trends in incidence, prevalence, and mortality of malignant melanoma in the UK from 1990 to 2021. Bayesian age-period-cohort model was applied to predict the disease burden for different age groups by 2030. From 1991 to 2021, melanoma incidence and prevalence in the UK exhibited distinct temporal patterns: a significant upward trend until 2015, particularly pronounced in individuals aged 60 and older, followed by a downward trend after 2015. By 2030, incidence and prevalence are projected to decrease, particularly in younger and middle-aged populations, with incidence expected to fall from 20.78/100 000 in 2020 to 11.90/100 000, and prevalence from 167.80/100 000 to 80.13/100 000. Mortality is also expected to decrease. However, high-risk groups, especially those aged 85 and above, are predicted to maintain higher incidence and prevalence rates. Despite a historical rise, melanoma incidence, prevalence, and mortality have declined since 2015 and are projected to continue declining through 2030. However, the elderly population remains at higher risk, underscoring the need for targeted public health interventions.

Cohort Differences in Physical Health and Disability in the United States and Europe

OBJECTIVES

Declines in mortality have historically been associated with improvements in physical health across generations. While life expectancy in most high-income countries continues to increase, there is evidence that younger generations, particularly in the United States, are less healthy than previous generations at the same age. We compared generational trends in physical health in the United States, England, and continental Europe to explore whether other regions have experienced a similar pattern of worsening health across cohorts.

METHODS

Using data from nationally representative studies of adults aged ≥50 years from the United States (Health and Retirement Study, n = 26,939), England (English Longitudinal Study of Ageing, n = 14,992) and 11 continental European countries (Survey of Health, Ageing and Retirement in Europe, n = 72,595), we estimated differences in the age-adjusted prevalence of self-reported chronic disease and disability and observer-measured health indicators across pseudo-birth cohorts (born <1925, 1925-1935, 1936-1945, 1946-1954, 1955-1959).

RESULTS

Age-adjusted prevalence of doctor-diagnosed chronic disease increased across successive cohorts in all regions. Trends in disability prevalence were more regionally varied. Still, in both the United States and Europe, we observed a structural break in disability trends, with declines observed in prewar cohorts slowing, stalling, or reversing for cohorts born since 1945.

DISCUSSION

In all regions, we found evidence for worsening health across cohorts, particularly for those born since 1945. While more chronic disease in younger cohorts need not necessarily translate to worse quality of life or higher rates of functional limitation, there is some suggestion that worsening chronic disease morbidity may be spilling over into worsening disability.

Generational differences in physical health and disability in the United States and Europe

Objectives

Declines in mortality have typically been associated with improvements in physical health across generations. While life expectancy in most high-income countries continues to increase, there is evidence that younger generations, particularly in the United States (US), are less healthy than previous generations at the same age. We compared generational trends in physical health in the US, England, and continental Europe to explore whether other regions have experienced a similar pattern of worsening health across cohorts.

Methods

Using data from nationally representative studies of adults aged ≥50 years from the US (Health and Retirement Study, n=26,939), England (English Longitudinal Study of Ageing, n=14,992) and 11 continental European countries (Survey of Health, Ageing and Retirement in Europe, n=72,595), we estimated differences in the age-adjusted prevalence of self-reported chronic disease and disability and observer-measured health indicators across pseudo-birth cohorts (born <1925, 1925-1935, 1936-1945, 1946-1954, 1955-1959).

Results

Age-adjusted prevalence of doctor-diagnosed chronic disease increased across cohorts in all regions. Trends in disability prevalence were more regionally varied. Still, in both the US and Europe, we observed a structural break in disability trends, with declines observed in pre-war cohorts slowing, stalling, or reversing for cohorts born since 1945.

Discussion

In all regions, we found evidence for worsening health across cohorts, particularly for those born since 1945. While more chronic disease in younger cohorts need not necessarily translate to worse quality of life or higher rates of functional limitation, there is some suggestion that worsening chronic disease morbidity may be spilling over into worsening disability.