title: Municipal distribution of bladder cancer mortality in Spain: possible role of mining and industry.
abstract: BACKGROUND
  Spain shows the highest bladder cancer incidence rates in men among European countries. The most important risk factors are tobacco smoking and occupational exposure to a range of different chemical substances, such as aromatic amines.
  
  
  METHODS
  This paper describes the municipal distribution of bladder cancer mortality and attempts to "adjust" this spatial pattern for the prevalence of smokers, using the autoregressive spatial model proposed by Besag, York and Molliè, with relative risk of lung cancer mortality as a surrogate.
  
  
  RESULTS
  It has been possible to compile and ascertain the posterior distribution of relative risk for bladder cancer adjusted for lung cancer mortality, on the basis of a single Bayesian spatial model covering all of Spain's 8077 towns. Maps were plotted depicting smoothed relative risk (RR) estimates, and the distribution of the posterior probability of RR>1 by sex. Towns that registered the highest relative risks for both sexes were mostly located in the Provinces of Cadiz, Seville, Huelva, Barcelona and Almería. The highest-risk area in Barcelona Province corresponded to very specific municipal areas in the Bages district, e.g., Suría, Sallent, Balsareny, Manresa and Cardona.
  
  
  CONCLUSIONS
  Mining/industrial pollution and the risk entailed in certain occupational exposures could in part be dictating the pattern of municipal bladder cancer mortality in Spain. Population exposure to arsenic is a matter that calls for attention. It would be of great interest if the relationship between the chemical quality of drinking water and the frequency of bladder cancer could be studied.
authors.affiliation: Environmental and Cancer Epidemiology Unit, National Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain. glabente@isciii.es
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Lopez-Abente
authors.forename: Nuria
authors.initials: N
authors.lastname: Aragones
authors.forename: Rebeca
authors.initials: R
authors.lastname: Ramis
authors.forename: Valentin
authors.initials: V
authors.lastname: Hernandez-Barrera
authors.forename: Beatriz
authors.initials: B
authors.lastname: Perez-Gomez
authors.forename: Antonio
authors.initials: A
authors.lastname: Escolar-Pujolar
authors.forename: Marina
authors.initials: M
authors.lastname: Pollan
mesh_terms: D000293:Adolescent; D000328:Adult; D001499:Bayes Theorem; D005260:Female; D006801:Humans; D007221:Industry; D008175:Lung Neoplasms / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D008906:Mining; D016273:Occupational Exposure / Q000009:adverse effects*; D016017:Odds Ratio; D015995:Prevalence; D012307:Risk Factors; D017678:Sex Distribution; D012907:Smoking / Q000009:adverse effects*; D013030:Spain / Q000453:epidemiology; D014504:Urban Health / Q000706:statistics & numerical data*; D001749:Urinary Bladder Neoplasms / Q000401:mortality*