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
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.
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
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
Flexible Bayesian P-splines for smoothing age-specific spatio-temporal mortality patterns
(SAGE, 2019) Goicoa Mangado, Tomás; Adin Urtasun, Aritz; Etxeberria Andueza, Jaione; Militino, Ana F.; Ugarte Martínez, María Dolores; Estadística, Informática y Matemáticas; Estatistika, Informatika eta Matematika; Institute for Advanced Materials and Mathematics - INAMAT2
In this paper age-space-time models based on one and two-dimensional P-splines with B-spline bases are proposed for smoothing mortality rates, where both xed relative scale and scale invariant two-dimensional penalties are examined. Model tting and inference are carried out using integrated nested Laplace approximations (INLA), a recent Bayesian technique that speeds up computations compared to McMC methods. The models will be illustrated with Spanish breast cancer mortality data during the period 1985-2010, where a general decline in breast cancer mortality has been observed in Spanish provinces in the last decades. The results reveal that mortality rates for the oldest age groups do not decrease in all provinces.
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
Prostate cancer incidence and mortality in Navarre (Spain)
(Gobierno de Navarra. Departamento de Salud, 2018) Etxeberria Andueza, Jaione; Guevara Eslava, Marcela; Moreno Iribas, Conchi; Burgui, Rosana; Delfrade Osinaga, J.; Floristan, Y.; Montesino Semper, Manuel F.; Ardanaz, Eva; Estatistika eta Ikerketa Operatiboa; Institute for Advanced Materials and Mathematics - INAMAT2; Estadística e Investigación Operativa
Fundamento. A nivel mundial, el cáncer de próstata es uno de los tumores malignos más comúnmente diagnosticados en los hombres. En este estudio, se analizan las tendencias de la incidencia y mortalidad de cáncer de próstata, global y por grupos de edad, para mostrar la situación epidemiológica pasada y actual de la enfermedad en Navarra (España). Método. Para el estudio se utilizaron los casos incidentes diagnosticados entre 1975 y 2010, y las muertes observadas entre 1975 y 2013. Los datos fueron proporcionados por el Registro de Cáncer de Navarra y el Instituto Nacional de Estadística respectivamente. Se calcularon las tasas de incidencia y mortalidad estandarizadas por edad, los puntos de cambio y el porcentaje de cambio anual (PCA) mediante modelos de regresión de joinpoint. Se usaron modelos unidimensionales de P-splines para estimar proyecciones hasta 2016. Resultados. Se observó un considerable incremento en las tasas de incidencia de cáncer de próstata en hombres de 45-74 años, con PCA de +4,5% (p<0,001), +9,5% (p<0,001) y +2,4% (p<0,05) en los periodos 1975-1990, 1990-2000 y 2000- 2010, respectivamente. En el grupo de mayores de 74 se registró un aumento de incidencia en el período 1975-1999 (PCA +3,3%, p<0,001), seguido de una disminución significativa hasta 2010 (PCA -4,0%, p<0,01). Las tasas de mortalidad aumentaron hasta 1995 (PCA +2,2%, p<0,001), mientras que descendieron en el periodo 1995-2013 (PCA -3.4%, p<0,001). Conclusión. Aunque las tasas globales de incidencia de cáncer de próstata parecen estabilizarse en 2002-2010 en Navarra, las tendencias fueron diferentes según los grupos de edad, aumentando en los hombres de 45-74 años y disminuyendo en el grupo de mayores de 74 años. Se observó una disminución en las tasas de mortalidad en ambos grupos de edad desde 1995. Cambios en el uso del antígeno prostático específico para cribado en los próximos años podrían afectar las futuras tendencias del cáncer de próstata. Palabras clave. Cáncer de Próstata. Incidencia. Mortalidad. Estimaciones. Tendencias
Open Access
Projections of lung cancer incidence by 2035 in 40 countries worldwide: population-based study
(JMIR Public Health and Surveillance, 2023) Luo, Ganfeng; Zhang, Yanting; Etxeberria Andueza, Jaione; Arnold, Melina; Cai, Xiuyu; Hao, Yuantao; Zou, Huachun; Estadística, Informática y Matemáticas; Estatistika, Informatika eta Matematika; Institute for Advanced Materials and Mathematics - INAMAT2
Background: The global burden of lung cancer (LC) is increasing. Quantitative projections of the future LC burden in different world regions could help optimize the allocation of resources and provide a benchmark for evaluating LC prevention and control interventions. Objective: We aimed to predict the future incidence of LC in 40 countries by 2035, with an emphasis on country- and sex-specific disparities. Methods: Data on LC incidence from 1978 to 2012 were extracted from 126 cancer registries of 40 countries in Cancer Incidence in Five Continents Volumes V-XI and used for the projection. Age-standardized incidence rates (ASRs) per 100,000 person-years and the number of incident cases were predicted through 2035, using the NORDPRED age-period-cohort model. Results: Global ASRs of the 40 studied countries were predicted to decrease by 23% (8.2/35.8) among males, from 35.8 per 100,000 person-years in 2010 to 27.6 in 2035, and increase by 2% (0.3/16.8) among females, from 16.8 in 2010 to 17.1 in 2035. The ASRs of LC among females are projected to continue increasing dramatically in most countries by 2035, with peaks after the 2020s in most European, Eastern Asian, and Oceanian countries, whereas the ASRs among males will continue to decline in almost all countries. The ASRs among females are predicted to almost reach those among males in Ireland, Norway, the United Kingdom, the Netherlands, Canada, the United States, and New Zealand in 2025 and in Slovenia in 2035 and even surpass those among males in Denmark in 2020 and in Brazil and Colombia in 2025. In 2035, the highest ASRs are projected to occur among males in Belarus (49.3) and among females in Denmark (36.8). The number of new cases in 40 countries is predicted to increase by 65.32% (858,000/1,314,000), from 1.31 million in 2010 to 2.17 million in 2035. China will have the largest number of new cases. Conclusions: LC incidence is expected to continue to increase through 2035 in most countries, making LC a major public health challenge worldwide. The ongoing transition in the epidemiology of LC highlights the need for resource redistribution and improved LC control measures to reduce future LC burden worldwide.