title: The striking geographical pattern of gastric cancer mortality in Spain: environmental hypotheses revisited.
abstract: BACKGROUND
  Gastric cancer is decreasing in most countries. While socioeconomic development is the main factor to which this decline has been attributed, enormous differences among countries and within regions are still observed, with the main contributing factors remaining elusive. This study describes the geographic distribution of gastric cancer mortality at a municipal level in Spain, from 1994-2003.
  
  
  METHODS
  Smoothed relative risks of stomach cancer mortality were obtained, using the Besag-York-Molliè autoregressive spatial model. Maps depicting relative risk (RR) estimates and posterior probabilities of RR being greater than 1 were plotted.
  
  
  RESULTS
  From 1994-2003, 62184 gastric cancer deaths were registered in Spain (7 percent of all deaths due to malignant tumors). The geographic pattern was similar for both sexes. RRs displayed a south-north and coast-inland gradient, with lower risks being observed in Andalusia, the Mediterranean coastline, the Balearic and Canary Islands and the Cantabrian seaboard. The highest risk was concentrated along the west coast of Galicia, broad areas of the Castile & Leon Autonomous community, the province of Cáceres in Extremadura, Lleida and other areas of Catalonia.
  
  
  CONCLUSIONS
  In Spain, risk of gastric cancer mortality displays a striking geographic distribution. With some differences, this persistent and unique pattern is similar across the sexes, suggesting the implication of environmental exposures from sources, such as diet or ground water, which could affect both sexes and delimited geographic areas. Also, the higher sex-ratios found in some areas with high risk of smoking-related cancer mortality in males support the role of tobacco in gastric cancer etiology.
authors.affiliation: Environmental and Cancer Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain. naragones@isciii.es
authors.forename: Nuria
authors.initials: N
authors.lastname: Aragonés
authors.forename: Beatriz
authors.initials: B
authors.lastname: Pérez-Gómez
authors.forename: Marina
authors.initials: M
authors.lastname: Pollán
authors.forename: Rebeca
authors.initials: R
authors.lastname: Ramis
authors.forename: Enrique
authors.initials: E
authors.lastname: Vidal
authors.forename: Virginia
authors.initials: V
authors.lastname: Lope
authors.forename: Javier
authors.initials: J
authors.lastname: García-Pérez
authors.forename: Elena
authors.initials: E
authors.lastname: Boldo
authors.forename: Gonzalo
authors.initials: G
authors.lastname: López-Abente
mesh_terms: D000818:Animals; D004781:Environmental Exposure; D005260:Female; D006801:Humans; D008297:Male; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013274:Stomach Neoplasms / Q000453:epidemiology / Q000401:mortality*