title: Ecological study of gastric cancer in Brazil: geographic and time trend analysis.
abstract: OBJECTIVE
  To investigate the geographic distributions and time trends of gastric cancer (GC) incidence and mortality in Brazil.
  
  
  METHODS
  An ecological study of the DATASUS registry was conducted by identifying hospitalizations for GC between January 2005 and December 2010. The data included information on the gender, age, and town of residence at the time of hospital admission and death.
  
  
  RESULTS
  The GC rates, adjusted according to available hospital beds, decreased from 13.8 per 100000 in 2005 to 12.7 per 100000 in 2010. The GC rates decreased more among the younger age groups, in which the male-to-female difference also decreased in comparison to the older age groups. Although the lethality rates tended to increase with age, young patients were proportionally more affected. The spatial GC distribution showed that the rates were higher in the south and southeast. However, while the rates decreased in the central-west and south, they increased in the northern regions. A geographic analysis showed higher rates of GC in more urbanized areas, with a coast-to-inland gradient. Geographically, GC lethality overlapped greatly with the hospital admission rates.
  
  
  CONCLUSIONS
  The results of this study support the hypothesis of a critical role for environmental factors in GC pathogenesis. The declining rates in young patients, particularly males, suggest a relatively recent decrease in the exposure to risk factors associated with GC. The spatial distribution of GC indicates an ongoing dynamic change within the Brazilian environment.
authors.affiliation: César Augusto Amorim, Antonio José Carneiro, Homero Soares Fogaça, Celeste Elia, Heitor Siffert Pereira de Souza, Serviço de Gastroenterologia, Departamento de Clínica Médica, Hospital Universitário, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ 21941-913, Brazil.
authors.forename: César Augusto
authors.initials: CA
authors.lastname: Amorim
authors.affiliation: César Augusto Amorim, Antonio José Carneiro, Homero Soares Fogaça, Celeste Elia, Heitor Siffert Pereira de Souza, Serviço de Gastroenterologia, Departamento de Clínica Médica, Hospital Universitário, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ 21941-913, Brazil.
authors.forename: Jéssica Pronestino
authors.initials: JP
authors.lastname: Moreira
authors.affiliation: César Augusto Amorim, Antonio José Carneiro, Homero Soares Fogaça, Celeste Elia, Heitor Siffert Pereira de Souza, Serviço de Gastroenterologia, Departamento de Clínica Médica, Hospital Universitário, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ 21941-913, Brazil.
authors.forename: Luisa
authors.initials: L
authors.lastname: Rial
authors.affiliation: César Augusto Amorim, Antonio José Carneiro, Homero Soares Fogaça, Celeste Elia, Heitor Siffert Pereira de Souza, Serviço de Gastroenterologia, Departamento de Clínica Médica, Hospital Universitário, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ 21941-913, Brazil.
authors.forename: Antonio José
authors.initials: AJ
authors.lastname: Carneiro
authors.affiliation: César Augusto Amorim, Antonio José Carneiro, Homero Soares Fogaça, Celeste Elia, Heitor Siffert Pereira de Souza, Serviço de Gastroenterologia, Departamento de Clínica Médica, Hospital Universitário, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ 21941-913, Brazil.
authors.forename: Homero Soares
authors.initials: HS
authors.lastname: Fogaça
authors.affiliation: César Augusto Amorim, Antonio José Carneiro, Homero Soares Fogaça, Celeste Elia, Heitor Siffert Pereira de Souza, Serviço de Gastroenterologia, Departamento de Clínica Médica, Hospital Universitário, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ 21941-913, Brazil.
authors.forename: Celeste
authors.initials: C
authors.lastname: Elia
authors.affiliation: César Augusto Amorim, Antonio José Carneiro, Homero Soares Fogaça, Celeste Elia, Heitor Siffert Pereira de Souza, Serviço de Gastroenterologia, Departamento de Clínica Médica, Hospital Universitário, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ 21941-913, Brazil.
authors.forename: Ronir Raggio
authors.initials: RR
authors.lastname: Luiz
authors.affiliation: César Augusto Amorim, Antonio José Carneiro, Homero Soares Fogaça, Celeste Elia, Heitor Siffert Pereira de Souza, Serviço de Gastroenterologia, Departamento de Clínica Médica, Hospital Universitário, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ 21941-913, Brazil.
authors.forename: Heitor Siffert Pereira
authors.initials: HS
authors.lastname: de Souza
mesh_terms: D017677:Age Distribution; D000367:Age Factors; D001938:Brazil / Q000453:epidemiology; D004777:Environment; D005260:Female; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D008297:Male; D012042:Registries; D012111:Residence Characteristics; D012307:Risk Factors; D017678:Sex Distribution; D012737:Sex Factors; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D013997:Time Factors
keywords: Ecological study; Gastric cancer; Hospitalization; Lethality rate