title: Spatio-temporal trends in gastric cancer mortality in Spain: 1975-2008.
abstract: OBJECTIVE
  There has been a downward trend in gastric cancer mortality worldwide. In Spain, a marked spatial aggregation of areas with excess mortality due to this cause has long been reported. This paper sought to analyse the evolution of gastric cancer mortality risk in Spanish provinces and explore the possible attenuation of the geographical pattern.
  
  
  METHODS
  We studied a series of gastric cancer mortality data by province, year of death, sex and age group using a conditional autoregressive (CAR) model that incorporated space, time and spatio-temporal interactions.
  
  
  RESULTS
  Gastric cancer mortality risk decreased in all Spanish provinces in both males and females. Overall, decreasing trends were more pronounced during the first years of the study period, largely due to a sharper fall in gastric cancer mortality risk among the older population. Recent decades have witnessed a slowing in the rate of decrease, especially among the younger age groups. In most areas, risk declined at a similar rate, thus serving to maintain interprovincial differences and the persistence of the geographical pattern, though with some differences. The north and northwest provinces were the areas with higher mortality risks in both sexes and age groups over the entire study period.
  
  
  CONCLUSIONS
  Despite the decline in gastric cancer mortality risk observed for the 50 Spanish provinces studied, geographical differences still persist in Spain, and the cluster of excess mortality in the north-west of the country remains in evidence.
authors.affiliation: Cancer and Environmental Epidemiology Area, 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: Tomás
authors.initials: T
authors.lastname: Goicoa
authors.forename: Marina
authors.initials: M
authors.lastname: Pollán
authors.forename: Ana F
authors.initials: AF
authors.lastname: Militino
authors.forename: Beatriz
authors.initials: B
authors.lastname: Pérez-Gómez
authors.forename: Gonzalo
authors.initials: G
authors.lastname: López-Abente
authors.forename: M Dolores
authors.initials: MD
authors.lastname: Ugarte
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D012306:Risk; D012737:Sex Factors; D013030:Spain / Q000453:epidemiology; D062211:Spatio-Temporal Analysis; D013274:Stomach Neoplasms / Q000453:epidemiology / Q000401:mortality*; D013997:Time Factors