Trends in mortality from malignant melanoma in Sweden, 1970-1996.
BACKGROUND
The rise in melanoma-related mortality in Sweden has been less pronounced than the increase in incidence. Interventional activities aimed at early detection may have contributed to this discrepancy.


METHODS
Individuals with malignant melanoma as the underlying cause of death between 1970 and 1996 (n = 7177) formed the basis of this study. Annual age-standardized mortality rates were calculated using the direct method of standardization with the Swedish population of 1970 as reference. Temporal trends in the standardized rates were evaluated using a log-linear model. The effects of age, period, and cohort on the mortality trends were estimated using a Poisson regression model.


RESULTS
Since the mid-1980s, melanoma-related mortality in Sweden has leveled off, with no further increase during the last 10-15 years. The contribution to the mortality from noncutaneous melanoma was proportionally stable (20-25%) during the studied period. In females, a significant decrease in mortality from cutaneous melanoma was shown for the period of 1987-1996 with an estimated annual decrease of -2.3% (95% confidence interval: -4.3 to -0.3). This trend appeared to be more pronounced in the Stockholm-Gotland region. The observed trends were best explained with the age-period model in both genders.


CONCLUSIONS
Melanoma-related mortality in Sweden has leveled off since the mid-1980s. During the period 1987-1996, a statistically significant downward trend was observed for females. This trend coincides with increased preventional activities.
Department of Oncology-Pathology, Radiumhemmet, Karolinska Hospital, Stockholm, Sweden.
G
G
Cohn-Cedermark
E
E
Månsson-Brahme
L E
LE
Rutqvist
O
O
Larsson
H
H
Johansson
U
U
Ringborg
D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D006266:Health Education; D006801:Humans; D008297:Male; D008545:Melanoma / Q000175:diagnosis / Q000401:mortality* / Q000517:prevention & control; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D015999:Multivariate Analysis; D012878:Skin Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000517:prevention & control; D016019:Survival Analysis; D013548:Sweden / Q000453:epidemiology