Epidemiologic transition of lung cancer mortality in Italy by sex, province of residence and birth cohort (1920-1929 to 1960-1969)

Abstract

AbstractSpace-time analysis of mortality risk is useful to evaluate the epidemiologic transitions at the subnational level. In this study, we analysed the death certificate records for lung cancer in Italy in 1995-2016, obtained from the Italian National Statistics Institute. Our objective was to investigate the spatio-temporal evolution of lung cancer mortality by sex and province of residence (n = 107) using the birth cohort as relevant time axis. We built space-time Bayesian models with space-time interactions. Among men (n = 554,829), mortality peaked in the 1920-1929 cohort, followed by a generalised decline. Among women (n = 158,619), we found novel original evidence for a peak in the 1955-1964 cohort, equivalent to a 35-year delay, with a downward trend being observed thereafter. Over time, the documented north-south decreasing mortality gradient has been replaced by a west-east decreasing gradient. Naples has become the province at highest risk in Italy, both among men and women. This pattern is consistent with an epidemiologic transition of risk factors for lung cancer to the south-west of the country and raises concerns, because 5-year age-standardised net survival from the disease in this geographic area is lower than in northern and central Italy. The variability of mortality rates among provinces has changed over time, with an increasing homogeneity for men and an opposite trend for women in the more recent birth cohorts. These unprecedented observations update substantially previous knowledge on lung cancer mortality in Italy.What’s new?The epidemiologic transition of lung cancer mortality in Italy (1995-2016) was studied using space-time Bayesian models with space-time interactions. Among men, mortality peaked in the 1920-1929 cohort, followed by a decline. Among women, novel evidence was found for a peak in the 1955-1964 cohort, equivalent to a 35-year delay, with a downward trend thereafter. The north-south decreasing gradient has been replaced by a west-east decreasing gradient, with Naples currently being the province at highest risk.