title: Oesophageal cancer mortality in Spain: a spatial analysis.
abstract: BACKGROUND
  Oesophageal carcinoma is one of the most common cancers worldwide. Its incidence and mortality rates show a wide geographical variation at a world and regional level. Geographic mapping of age-standardized, cause-specific death rates at a municipal level could be a helpful and powerful tool for providing clues leading to a better understanding of its aetiology.
  
  
  METHODS
  This study sought to describe the geographic distribution of oesophageal cancer mortality for Spain's 8077 towns, using the autoregressive spatial model proposed by Besag, York and Mollié. Maps were plotted, depicting standardised mortality ratios, smoothed relative risk (RR) estimates, and the spatial pattern of the posterior probability of RR being greater than 1.
  
  
  RESULTS
  Important differences associated with area of residence were observed in risk of dying from oesophageal cancer in Spain during the study period (1989-1998). Among men, excess risk appeared across the north of the country, along a band spanning the length of the Cantabrian coastline, Navarre, the north of Castile & León and the north-west of La Rioja. Excess risk was likewise observed in the provinces of Cadiz and part of Seville in Andalusia, the islands of Tenerife and Gran Canaria, and some towns in the Barcelona and Gerona areas. Among women, there was a noteworthy absence of risk along the mid-section of the Cantabrian seaboard, and increases in mortality, not observed for men, in the west of Extremadura and south-east of Andalusia.
  
  
  CONCLUSIONS
  These major gender- and area-related geographical differences in risk would seem to reflect differences in the prevalence of some well-established and modifiable risk factors, including smoking, alcohol consumption, obesity and diet. In addition, excess risks were in evidence for both sexes in some areas, possibly suggesting the implication of certain local environmental or socio-cultural factors. From a public health standpoint, small-area studies could be very useful for identifying locations where epidemiological research and intervention measures ought to receive priority, given the potential for reducing risk in certain places.
authors.affiliation: Environmental and Cancer Epidemiology Unit, National Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain. naragones@isciii.es
authors.forename: Nuria
authors.initials: N
authors.lastname: Aragonés
authors.forename: Rebeca
authors.initials: R
authors.lastname: Ramis
authors.forename: Marina
authors.initials: M
authors.lastname: Pollán
authors.forename: Beatriz
authors.initials: B
authors.lastname: Pérez-Gómez
authors.forename: Diana
authors.initials: D
authors.lastname: Gómez-Barroso
authors.forename: Virginia
authors.initials: V
authors.lastname: Lope
authors.forename: Elena Isabel
authors.initials: EI
authors.lastname: Boldo
authors.forename: Javier
authors.initials: J
authors.lastname: García-Pérez
authors.forename: Gonzalo
authors.initials: G
authors.lastname: López-Abente
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000473:pathology; D003710:Demography; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000473:pathology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012042:Registries; D017678:Sex Distribution; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate