title: Mortality trend for tumor correlated immune system in hyperendemic area of HCV infection in southern Italy: joinpoint analysis.
abstract: BACKGROUND
  In many regions of southern Italy, hepatitis C virus (HCV) infection represents a major health problem (with a prevalence rate between 6% and 13%). HCV is associated with different kinds of neoplasms such as non-Hodgkin lymphomas (NHL), and with auto-immune diseases (cryoglobulinemia), which develop after the virus has caused immune system alterations.
  
  
  OBJECTIVE
  To provide updated information on trends in mortality in a major metropolitan area of southern Italy from NHL, multiple myeloma and Hodgkin disease we analyzed cancer mortality data from 1988 to 2009.
  
  
  METHODS
  Mortality data were extracted from National death certificates by age groups, gender, residence and cause of death by the Italian national institute of statistics (ISTAT). Age-standardized mortality rates (SMR) were computed applying the direct method and using the world standard population. To quantify the recent direction of temporal trends in older populations over time, truncated age-adjusted mortality rates were calculated for people aged 65 years and older. Cancer mortality trends were described using their estimated annual percent change (EAPC) and related 95% Confidence Interval (CI).
  
  
  RESULTS
  Statistically significant increasing EAPC was found among women for NHL (+2.0% / year), while statistically significant decrease was found among men and women for HD (-3.5% / year, -3.4% / year, respectively). No statistically significant EAPC was found for multiple myeloma.
  
  
  CONCLUSIONS
  The association between viral hepatitis and NHL in the area of interest might provide some degree of explanation to this finding. Our data confirm that due to epidemic infection of HCV in the area of Naples, a high mortality for NHL persists, moreover the adoption of standard therapeutic protocols administered in full accordance with an evidence-based approach and current guidelines explain reduced mortality from Hodgkin lymphomas.
authors.affiliation: Epidemiology Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale", IRCCS, Naples, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Montella
authors.forename: Matteo
authors.initials: M
authors.lastname: Malvezzi
authors.forename: Maria
authors.initials: M
authors.lastname: Grimaldi
authors.forename: Flavia
authors.initials: F
authors.lastname: Nocerino
authors.forename: Ferdinando
authors.initials: F
authors.lastname: Frigeri
authors.forename: Antonio
authors.initials: A
authors.lastname: Pinto
authors.forename: Aldo
authors.initials: A
authors.lastname: Giudice
authors.forename: Anna
authors.initials: A
authors.lastname: Crispo
keywords: Analysis; Hepacivirus; Lymphoma, Non-Hodgkin; Mortality