Open Access
Epidemiology of non-steroidal anti-inflammatory drugs consumption in Spain. The MCC-Spain study
(BMC, 2018) Gómez Acebo, Inés; Dierssen Sotos, Trinidad; Pedro, María de; Pérez Gómez, Beatriz; Castaño Vinyals, Gemma; Fernández Villa, Tania; Palazuelos Calderón, Camilo; Amiano, Pilar; Etxeberria Andueza, Jaione; Estatistika, Informatika eta Matematika; Institute for Advanced Materials and Mathematics - INAMAT2; Estadística, Informática y Matemáticas
Background: Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used despite their risk of gastrointestinal bleeding or cardiovascular events. We report the profile of people taking NSAIDs in Spain, and we include demographic factors, health-related behaviours and cardiovascular disease history. Methods: Four thousand sixtyparticipants were selected using a pseudorandom number list from Family Practice lists in 12 Spanish provinces. They completed a face-to-face computerized interview on their NSAID consumption, demographic characteristics, body mass index, alcohol and tobacco consumption and medical history. In addition, participants completed a self-administered food-frequency and alcohol consumption questionnaire. Factors associated with ever and current NSAID consumption were identified by logistic regression. Results: Women consumed more non-aspirin NSAIDs (38.8% [36.7-41.0]) than men (22.3 [20.5-24.2]), but men consumed more aspirin (11.7% [10.3-13.2]) than women (5.2% [4.3-6.3]). Consumption of non-aspirin NSAIDs decrease with age from 44.2% (39.4-49.1) in younger than 45 to 21.1% (18.3-24.2) in older than 75, but the age-pattern for aspirin usage was the opposite. Aspirin was reported by about 11% patients, as being twice as used in men (11.7%) than in women (5.2%); its consumption increased with age from 1.7% (< 45 years old) to 12.4% (>= 75 years old). Aspirin was strongly associated with the presence of cardiovascular risk factors or established cardiovascular disease, reaching odds ratios of 15.2 (7.4-31.2) in women with acute coronary syndrome, 13.3 (6.2-28.3) in women with strokes and 11.1 (7.8-15.9) in men with acute coronary syndrome. Participants with cardiovascular risk factors or diseases consumed as much non-aspirin NSAID as participants without such conditions. Conclusions: Non-aspirin NSAIDs were more consumed by women and aspirin by men. The age patterns of aspirin and non-aspirin NSAIDs were opposite: the higher the age, the lower the non-aspirin NSAIDs usage and the higher the aspirin consumption. People with cardiovascular risk factors or diseases consumed more aspirin, but they did not decrease their non-aspirin NSAIDs usage.
Open Access
Adherence to the Mediterranean diet reduces mortality in the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Spain)
(Cambridge University Press, 2011) Buckland, Genevieve; Agudo, Antonio; Travier, Noemie; Huerta, José María; Cirera, Lluís; Tormo, María José; Navarro, Carmen; Chirlaque, María Dolores; Moreno Iribas, Conchi; Ardanaz, Eva; Barricarte Gurrea, Aurelio; Etxeberria Andueza, Jaione; Marín, Pilar; Quirós, J. Ramón; Redondo, María Luisa; Larrañaga, Nerea; Amiano, Pilar; Dorronsoro, Miren; Arriola, Larraitz; Basterretxea, Mikel; Sánchez, María José; Molina, Esther; González, Carlos A.; Estadística e Investigación Operativa; Estatistika eta Ikerketa Operatiboa; Gobierno de Navarra / Nafarroako Gobernua
Epidemiological studies show that adherence to a Mediterranean diet (MD) increases longevity; however, few studies are restricted to Mediterranean populations or explore the effect of a MD pattern that directly incorporates olive oil. Therefore the relationship between adherence to the MD and mortality was studied within the the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Spain). The EPIC-Spain analysis included 40 622 participants (37·7% males) aged 29–69 years who were recruited from five Spanish regions in 1992–1996. During a mean follow-up of 13·4 years, 1855 deaths were documented: 913 from cancer, 399 from CVD, 425 from other causes and 118 from unknown causes of death. Risk of all-cause and cause-specific mortality was assessed according to the level of adherence to a relative MD (rMED) score, measured using an 18-unit scale incorporating nine selected dietary components. A high compared with a low rMED score was associated with a significant reduction in mortality from all causes (hazard ratio (HR) 0·79; 95% CI 0·69, 0·91), from CVD (HR 0·66; 95% CI 0·49, 0·89), but not from overall cancer (HR 0·92; 95% CI 0·75, 1·12). A 2-unit increase in rMED score was associated with a 6% (P,0·001) decreased risk of all-cause mortality. A high olive oil intake and moderate alcohol consumption contributed most to this association. In this Spanish cohort, following an olive oil-rich MD was related to a significant reduction in all-cause mortality, and reduced the risk of mortality from CVD. These results support the important role that the MD pattern has on reducing mortality in Mediterranean countries.
Open Access
Estimating LOCP cancer mortality rates in small domains in Spain using its relationship with lung cancer
(Nature Research, 2021) Retegui Goñi, Garazi; Etxeberria Andueza, Jaione; Ugarte Martínez, María Dolores; Estatistika, Informatika eta Matematika; Institute for Advanced Materials and Mathematics - INAMAT2; Estadística, Informática y Matemáticas; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa
The distribution of lip, oral cavity, and pharynx (LOCP) cancer mortality rates in small domains (defined as the combination of province, age group, and gender) remains unknown in Spain. As many of the LOCP risk factors are preventable, specific prevention programmes could be implemented but this requires a clear specification of the target population. This paper provides an in-depth description of LOCP mortality rates by province, age group and gender, giving a complete overview of the disease. This study also presents a methodological challenge. As the number of LOCP cancer cases in small domains (province, age groups and gender) is scarce, univariate spatial models do not provide reliable results or are even impossible to fit. In view of the close link between LOCP and lung cancer, we consider analyzing them jointly by using shared component models. These models allow information-borrowing among diseases, ultimately providing the analysis of cancer sites with few cases at a very disaggregated level. Results show that males have higher mortality rates than females and these rates increase with age. Regions located in the north of Spain show the highest LOCP cancer mortality rates.
Open Access
Multivariate Bayesian models with flexible shared interactions for analyzing spatio-temporal patterns of rare cancers
(Springer, 2024) Retegui Goñi, Garazi; Etxeberria Andueza, Jaione; Ugarte Martínez, María Dolores; Estadística, Informática y Matemáticas; Estatistika, Informatika eta Matematika; Institute for Advanced Materials and Mathematics - INAMAT2; Universidad Pública de Navarra - Nafarroako Unibertsitate Publikoa
Rare cancers afect millions of people worldwide each year. However, estimating incidence or mortality rates associated with rare cancers presents important difculties and poses new statistical methodological challenges. In this paper, we expand the collection of multivariate spatio-temporal models by introducing adaptable shared spatio-temporal components to enable a comprehensive analysis of both incidence and cancer mortality in rare cancer cases. These models allow the modulation of spatio-temporal efects between incidence and mortality, allowing for changes in their relationship over time. The new models have been implemented in INLA using r-generic constructions. We conduct a simulation study to evaluate the performance of the new spatio-temporal models. Our results show that multivariate spatio-temporal models incorporating a fexible shared spatio-temporal term outperform conventional multivariate spatio-temporal models that include specifc spatio-temporal efects for each health outcome. We use these models to analyze incidence and mortality data for pancreatic cancer and leukaemia among males across 142 administrative health care districts of Great Britain over a span of nine biennial periods (2002-2019)
Open Access
Age- and sex-specific spatio-temporal patterns of colorectal cancer mortality in Spain (1975-2008)
(BioMed Central, 2014) Etxeberria Andueza, Jaione; Ugarte Martínez, María Dolores; Goicoa Mangado, Tomás; Militino, Ana F.; Estadística e Investigación Operativa; Estatistika eta Ikerketa Operatiboa
In this paper, space-time patterns of colorectal cancer (CRC) mortality risks are studied by sex and age group (50-69, ≥70) in Spanish provinces during the period 1975-2008. Space-time conditional autoregressive models are used to perform the statistical analyses. A pronounced increase in mortality risk has been observed in males for both age-groups. For males between 50 and 69 years of age, trends seem to stabilize from 2001 onward. In females, trends reflect a more stable pattern during the period in both age groups. However, for the 50-69 years group, risks take an upward trend in the period 2006-2008 after the slight decline observed in the second half of the period. This study offers interesting information regarding CRC mortality distribution among different Spanish provinces that could be used to improve prevention policies and resource allocation in different regions.
Open Access
La estadística en la investigación en ciencias de la salud
(Sociedad de Estadística e Investigación Operativa, 2020) Martínez Baz, Iván; Alejos Ferreras, Belén; Ramis Prieto, Rebeca; Arostegui Madariaga, Inmaculada; Arrospide Elgarresta, Arantzazu; Belzunegui Otano, Tomás; Cadarso Suárez, Carmen María; Navarrete Muñoz, Eva María; Ugarte Martínez, María Dolores; Etxeberria Andueza, Jaione; Pijoan Zubizarreta, José Ignacio; Estadística, Informática y Matemáticas; Estatistika, Informatika eta Matematika
Statistics and health research are closely related. Statistical methods and analysis are essential components in any research field and have acquired a relevant role in recent decades. In this context, the Universidad Pública de Navarra offered a summer course entitled ‘Statistics in Health Sciences. A look from research’ in order to divulge the role of statistics in health sciences research. To this end, health research professionals with extensive experience, with different backgrounds and areas of profesional interest (academic, health, epidemiological or statistical) were convened to present their vision of the topic. All participants agreed on the need of setting multidisciplinary teams, including health and statistician professionals, and greater synergy between the health and academic fields.The statistical profile is becoming more relevant role within health research teams, especially after the acquisition of complementary skills in epidemiology and public health.
Open Access
Using mortality to predict incidence for rare and lethal cancers in very small areas
(VCH Publishers, 2022) Etxeberria Andueza, Jaione; Goicoa Mangado, Tomás; Ugarte Martínez, María Dolores; Estadística, Informática y Matemáticas; Estatistika, Informatika eta Matematika; Institute for Advanced Materials and Mathematics - INAMAT2
Incidence and mortality figures are needed to get a comprehensive overview of cancer burden. In many countries, cancer mortality figures are routinely recorded by statistical offices, whereas incidence depends on regional cancer registries. However, due to the complexity of updating cancer registries, incidence numbers become available 3 or 4 years later than mortality figures. It is, therefore, necessary to develop reliable procedures to predict cancer incidence at least until the period when mortality data are available. Most of the methods proposed in the literature are designed to predict total cancer (except nonmelanoma skin cancer) or major cancer sites. However, less frequent lethal cancers, such as brain cancer, are generally excluded from predictions because the scarce number of cases makes it difficult to use univariate models. Our proposal comes to fill this gap and consists of modeling jointly incidence and mortality data using spatio-temporal models with spatial and age shared components. This approach allows for predicting lethal cancers improving the performance of individual models when data are scarce by taking advantage of the high correlation between incidence and mortality. A fully Bayesian approach based on integrated nested Laplace approximations is considered for model fitting and inference. A validation process is also conducted to assess the performance of alternative models. We use the new proposals to predict brain cancer incidence rates by gender and age groups in the health units of Navarre and Basque Country (Spain) during the period 2005-2008.
Open Access
Características y métodos estadísticos empleados en los artículos originales publicados en las revistas de salud pública en España
(Gobierno de Navarra, 2018) Martínez Baz, Iván; Delfrade Osinaga, J.; Etxeberria Andueza, Jaione; Estadística, Informática y Matemáticas; Estatistika, Informatika eta Matematika
Background. To describe the characteristics and statistical methods used in the original articles published in Gaceta Sanitaria, Revista Española de Salud Pública y Anales del Sistema Sanitario de Navarra, the Spanish public health journals in Spain indexed in the 2016 JRC. Methods. All articles published in these journals in 2007, 2012 and 2017 were reviewed. For each article, general aspects (year, journal, language, area) and statistical characteristics (design, purpose, method and software) were recorded. Results. A total of 310 articles were reviewed, 73% of them were cross-sectional studies. Evaluation and health services (24%) and chronic diseases were the most frequent areas. During the 2007-2017 period there was an increase in both the number of works written in English (4 vs 20%, p<0.001) and by women as the main (46 vs 62%, p=0.028) or senior authors (27 vs 36%, p=0.029). Significant changes concerning type of analysis were not detected (p=0.933). Conclusions. The characteristics and statistical methods used in scientific publications have not been modified in recent years. However, publications written in English have increased and women are playing a more relevant role in authorship.
Open Access
Predicting cancer incidence in regions without population-based cancer registries using mortality
(Oxford University Press, 2023) Retegui Goñi, Garazi; Etxeberria Andueza, Jaione; Riebler, Andrea; Ugarte Martínez, María Dolores; Estadística, Informática y Matemáticas; Estatistika, Informatika eta Matematika; Institute for Advanced Materials and Mathematics - INAMAT2; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa, PJUPNA2018-11
Cancer incidence numbers are routinely recorded by national or regional population-based cancer registries (PBCRs). However, in most southern European countries, the local PBCRs cover only a fraction of the country. Therefore, national cancer incidence can be only obtained through estimation methods. In this paper, we predict incidence rates in areas without cancer registry using multivariate spatial models modelling jointly cancer incidence and mortality. To evaluate the proposal, we use cancer incidence and mortality data from all the German states. We also conduct a simulation study by mimicking the real case of Spain considering different scenarios depending on the similarity of spatial patterns between incidence and mortality, the levels of lethality, and varying the amount of incidence data available. The new proposal provides good interval estimates in regions without PBCRs and reduces the relative error in estimating national incidence compared to one of the most widely used methodologies.
Open Access
Possible role of chondroitin sulphate and glucosamine for primary prevention of colorectal cancer. Results from the MCC-Spain study
(Springer Nature, 2018) Ibáñez Sanz, Gemma; Díez Villanueva, Anna; Vilorio Marqués, Laura; Gracia, Esther; Aragonés, Nuria; Olmedo Requena, Rocío; Llorca, Javier; Vidán, Juana; Amiano, Pilar; Nos, Pilar; Fernández Tardón, Guillermo; Rada, Ricardo; Chirlaque, María Dolores; Guinó, Elisabet; Dávila Batista, Verónica; Castaño Vinyals, Gemma; Pérez Gómez, Beatriz; Mirón Pozo, Benito; Dierssen Sotos, Trinidad; Etxeberria Andueza, Jaione; Molinuevo, Amaia; Álvarez Cuenllas, Begoña; Kogevinas, Manolis; Pollán, Marina; Moreno, Víctor; Estadística e Investigación Operativa; Estatistika eta Ikerketa Operatiboa
A safe and effective colorectal cancer (CRC) chemoprevention agent remains to be discovered. We aim to evaluate the association between the use of glucosamine and/or chondroitin sulphate and risk of colorectal cancer (CRC) in the MCC-Spain study, a case-control study performed in Spain that included 2140 cases of CRC and 3950 population controls. Subjects were interviewed on sociodemographic factors, lifestyle, family and medical history and regular drug use. Adjusted odds ratios and their 95% confidence intervals were estimated. The reported frequency of chondroitin and/or glucosamine use was 2.03% in controls and 0.89% in cases. Users had a reduced risk of CRC (OR: 0.47; 95% CI: 0.28–0.79), but it was no longer significant when adjusted for NSAID (nonsteroidal anti-inflammatory drugs) use (OR: 0.82; 95% CI: 0.47–1.40). A meta-analysis with previous studies suggested a protective effect, overall and stratified by NSAID use (OR: 0.77; 95% CI: 0.62–0.97). We have not found strong evidence of an independent preventive effect of CG on CRC in our population because the observed effects of our study could be attributed to NSAIDs concurrent use. These results merit further research due to the safety profile of these drugs.

Etxeberria Andueza, Jaione

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