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Cervantes-Amat M.,CIBER ISCIII | Cervantes-Amat M.,Carlos III Institute of Health | Lopez-Abente G.,CIBER ISCIII | Lopez-Abente G.,Carlos III Institute of Health | And 13 more authors.
BMC Cancer | Year: 2015

Background: In Spain, cervical cancer prevention is based on opportunistic screening, due to the disease's traditionally low incidence and mortality rates. Changes in sexual behaviour, tourism and migration have, however, modified the probability of exposure to human papilloma virus among Spaniards. This study thus sought to evaluate recent cervical cancer mortality trends in Spain. Methods: We used annual female population figures and individual records of deaths certified as cancer of cervix, reclassifying deaths recorded as unspecified uterine cancer to correct coding quality problems. Joinpoint models were fitted to estimate change points in trends, as well as the annual (APC) and average annual percentage change. Log-linear Poisson models were also used to study age-period-cohort effects on mortality trends and their change points. Results: 1981 marked the beginning of a decline in cervical cancer mortality (APC1981-2003: -3.2; 95% CI:-3.4;-3.0) that ended in 2003, with rates reaching a plateau in the last decade (APC2003-2012: 0.1; 95% CI:-0.9; 1.2). This trend, which was observable among women aged 45-46 years (APC2003-2012: 1.4; 95% CI:-0.1;2.9) and over 65 years (APC2003-2012: -0.1; 95% CI:-1.9;1.7), was clearest in Spain's Mediterranean and Southern regions. Conclusions: The positive influence of opportunistic screening is not strong enough to further reduce cervical cancer mortality rates in the country. Our results suggest that the Spanish Health Authorities should reform current prevention programmes and surveillance strategies in order to confront the challenges posed by cervical cancer. © Cervantes-Amat et al.; licensee BioMed Central.

Galan I.,Institute Salud Carlos III | Galan I.,Autonomous University of Madrid | Simon L.,Institute Salud Carlos III | Flores V.,Institute Salud Carlos III | And 10 more authors.
BMJ Open | Year: 2015

Objective: Recent research has assessed the impact of tobacco laws on cardiovascular and respiratory morbidity. In this study, we also examined whether the association between the implementation of the 2005 Spanish smoking ban and hospital admissions for cardiovascular and respiratory diseases varies according to the adjustment for potential confounders. Design: Ecological time series analysis. Setting: Residents of Madrid and Barcelona cities (Spain). Outcome: Data on daily emergency room admissions for acute myocardial infarction, cerebrovascular disease, chronic obstructive pulmonary disease (COPD), and asthma derived from the 2003a-2006 Spanish hospital admissions registry. Methods: Changes in admission rates between 2006 and the 2003a-2005 period were estimated using additive Poisson models allowing for overdispersion adjusted for secular trend in admission, seasonality, day of the week, temperature, number of flu and acute respiratory infection cases, pollution levels, tobacco consumption prevalence and, for asthma cases, pollen count. Results: In Madrid, fully adjusted models failed to detect significant changes in hospital admission rates for any disease during the study period. In Barcelona, however, hospital admissions decreased by 10.2% (95% CI 3.8% to 16.1%) for cerebrovascular diseases and by 16.0% (95% CI 7.0% to 24.1%) for COPD. Substantial changes in effect estimates were observed on adjustment for linear or quadratic trend. Effect estimates for asthma-related admissions varied substantially when adjusting for pollen count in Madrid, and for seasonality and tobacco consumption in Barcelona. Conclusions: Our results confirm that the potential impact of a smoking ban must be adjusted for the underlying secular trend. In asthma-related admissions, pollen count, seasonality and tobacco consumption must be specified in the model. The substantial variability in effects detected between the two cities of Madrid and Barcelona lends strong support for a nationwide study to assess the overall effect of a smoking ban in Spain and identify the causes of the observed heterogeneity.

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