title: Model-based patterns in stomach cancer mortality worldwide.
abstract: The decrease in stomach cancer mortality was not because of specific interventions, and is likely that different countries follow a similar model of variation. Here, we aimed to identify model-based patterns in the time trends of stomach cancer mortality worldwide. Stomach cancer mortality rates were retrieved for 62 countries from the WHO mortality database. Sex-specific mixed models were used to describe time trends in age-standardized rates between 1980 and 2010 (age group 35-74 years; World standard population). Three patterns, similar for men and women, were identified through model-based clustering. Pattern 1 presented the highest mortality rates in 1980 (median: men, 81.5/100 000; women, 34.4/100 000) and pattern 3 the lowest ones (median: men, 24.4/100 000; women, 12.4/100 000). The decrease in mortality rates was greater in 1980-1995 than during 1996-2010. Assuming that the patterns characterized by the highest rates precede temporally those with lower mortality, the overlap of model predictions supports a 20-year lag between adjacent patterns. We propose a model for the variation in stomach cancer mortality with three stages that develop sequentially through a period of ∼70 years. The countries with the lowest mortality had the highest proportional decrease in mortality rates.
authors.affiliation: aDepartment of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School bInstitute of Public Health, University of Porto (ISPUP), Porto, Portugal cDepartment of Epidemiology, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri dDepartment of Medical Sciences and Public Health, University of Milan, Milan, Italy.
authors.forename: Bárbara
authors.initials: B
authors.lastname: Peleteiro
authors.forename: Milton
authors.initials: M
authors.lastname: Severo
authors.forename: Carlo
authors.initials: C
authors.lastname: La Vecchia
authors.forename: Nuno
authors.initials: N
authors.lastname: Lunet
mesh_terms: D000328:Adult; D017677:Age Distribution; D016000:Cluster Analysis; D005260:Female; D014943:Global Health / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009026:Mortality / Q000639:trends; D017678:Sex Distribution; D013274:Stomach Neoplasms / Q000401:mortality*