Relation between mortality trends of cardiovascular diseases and selected cancers in the European Union, in 1970–2017. Focus on cohort and period effects

• Published in: European journal of cancer (1990) 2018-11, Vol.103, p.341-355
• Main Authors: Malvezzi, M., Carioli, G., Bertuccio, P., Negri, E., La Vecchia, C.
• Format: Article
• Language: English
• Subjects: Adenomatous polyposis coli; Adult; Age; Age factors; Cancer; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - mortality; Cerebrovascular diseases; Cohort effect; Cohort Studies; Colorectal cancer; Coronary artery disease; Coronary heart disease; Data bases; Data processing; Death rate; Europe; Female; Heart diseases; History, 20th Century; History, 21st Century; Humans; Intestine; Lung cancer; Lung diseases; Male; Middle Aged; Mortality; Neoplasms; Neoplasms - mortality; Pancreas; Pancreatic cancer; Prostate; Regression analysis; Regression models; Stomach; Stomach cancer; Tobacco; Trends; Vascular diseases
• ISSN: 0959-8049; 1879-0852
• DOI: 10.1016/j.ejca.2018.06.018

To characterise mortality trends from major non-communicable diseases in the European Union (EU) analysing data from the World Health Organization (WHO) Mortality Database. We obtained EU population and death certification data for major non-communicable diseases, i.e. seven cancer sites (stomach, intestine, pancreas, lung, breast, prostate and haematopoietic), total cancers, coronary heart diseases (CHDs) and cerebrovascular diseases (CVDs) from the WHO Mortality Database over the 1970 and 2012 period. We computed age-standardised rates (world standard population) and applied joinpoint regression models to identify temporal trends and age period cohort (APC) models to disentangle the effects of age, period of death and cohort of birth on mortality. In 2012, 2.4 million deaths were recorded in the EU (1.3 million from cancers and 1.1 million from CHD and CVD combined). Over the last decade, mortality from cancer fell by 14% in men and 8% in women, resulting in age-standardised rates of 144 and 88/100,000 persons, respectively, in 2012. The only exceptions to the general downward trends were pancreatic cancer and female lung cancer. Both cardiovascular diseases mortality fell over 35% in both sexes with rates of 60 and 28/100,000 for CHD, and of 30 and 23/100,000 for CVD, in men and women, respectively, in 2012. Overall trends in mortality rates from non-communicable diseases in the EU were favourable, and the joinpoint and APC models indicated these trends are likely to continue in the near future. Lack of progress in tobacco-related mortality in women underlines the importance of female-specific anti-tobacco policies. •There was a substantial decline in total mortality in the European Union over the last 4 decades.•This was largely driven by vascular disease, and more recently by cancers as well.•The fall in smoking in men accounts for part of the fall in mortality.•Control of risk factors and management explains vascular mortality disease trends.•Improved diagnosis and management had a role in cancer mortality too.