title: Clustering asian and north african countries according to trend of colon and rectum cancer mortality rates: an application of growth mixture models.
abstract: BACKGROUND
  Colorectal cancer is the second most common cause of cancer death with half a million deaths per year. Incidence and mortality rates have demonstrated notable changes in Asian and African countries during the last few decades. In this study, we first aimed to determine the trend of colorectal cancer mortality rate in each Institute for Health Metrics and Evaluation (IHME) region, and then re-classify them to find more homogenous classes.
  
  
  METHODS
  Our study population consisted of 52 countries of Asia and North Africa in six IHME pre-defined regions for both genders and age-standardized groups from 1990 to 2010.We first applied simple growth models for pre-defined IHME regions to estimate the intercepts and slopes of mortality rate trends. Then, we clustered the 52 described countries using the latent growth mixture modeling approach for classifying them based on their colorectal mortality rates over time.
  
  
  RESULTS
  Statistical analysis revealed that males and people in high income Asia pacific and East Asia countries were at greater risk of death from colon and rectum cancer. In addition, South Asia region had the lowest rates of mortality due to this cancer. Simple growth modeling showed that majority of IHME regions had decreasing trend in mortality rate of colorectal cancer. However, re-classification these countries based on their mortality trend using the latent growth mixture model resulted in more homogeneous classes according to colorectal mortality trend.
  
  
  CONCLUSIONS
  In general, our statistical analyses showed that most Asian and North African countries had upward trend in their colorectal cancer mortality. We therefore urge the health policy makers in these countries to evaluate the causes of growing mortality and study the interventional programs of successful countries in managing the consequences of this cancer.
authors.affiliation: Department of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran E-mail : Anita.Mansouri@sbmu.ac.ir.
authors.forename: Farid
authors.initials: F
authors.lastname: Zayeri
authors.forename: Ali
authors.initials: A
authors.lastname: Sheidaei
authors.forename: Anita
authors.initials: A
authors.lastname: Mansouri
mesh_terms: D000349:Africa / Q000453:epidemiology; D001208:Asia / Q000453:epidemiology; D016000:Cluster Analysis; D003110:Colonic Neoplasms / Q000453:epidemiology / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D015233:Models, Statistical; D011379:Prognosis; D012004:Rectal Neoplasms / Q000453:epidemiology / Q000401:mortality*; D015996:Survival Rate