title: Trends in colorectal cancer mortality in Europe: retrospective analysis of the WHO mortality database.
abstract: OBJECTIVE
  To examine changes in colorectal cancer mortality in 34 European countries between 1970 and 2011.
  
  
  METHODS
  Retrospective trend analysis.
  
  
  METHODS
  World Health Organization mortality database.
  
  
  METHODS
  Deaths from colorectal cancer between 1970 and 2011. Profound changes in screening and treatment efficiency took place after 1988; therefore, particular attention was paid to the evolution of colorectal cancer mortality in the subsequent period.
  
  
  METHODS
  Time trends in rates of colorectal cancer mortality, using joinpoint regression analysis. Rates were age adjusted using the standard European population.
  
  
  RESULTS
  From 1989 to 2011, colorectal cancer mortality increased by a median of 6.0% for men and decreased by a median of 14.7% for women in the 34 European countries. Reductions in colorectal cancer mortality of more than 25% in men and 30% in women occurred in Austria, Switzerland, Germany, the United Kingdom, Belgium, the Czech Republic, Luxembourg, and Ireland. By contrast, mortality rates fell by less than 17% in the Netherlands and Sweden for both sexes. Over the same period, smaller or no declines occurred in most central European countries. Substantial mortality increases occurred in Croatia, the former Yugoslav republic of Macedonia, and Romania for both sexes and in most eastern European countries for men. In countries with decreasing mortality, reductions were more important for women of all ages and men younger than 65 years. In the 27 European Union member states, colorectal cancer mortality fell by 13.0% in men and 27.0% in women, compared with corresponding reductions of 39.8% and 38.8% in the United States.
  
  
  CONCLUSIONS
  Over the past 40 years, there has been considerable disparity in the level of colorectal cancer mortality between European countries, as well as between men and women and age categories. Countries with the largest reductions in colorectal cancer mortality are characterised by better accessibility to screening services, especially endoscopic screening, and specialised care.
authors.affiliation: Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
authors.forename: Driss
authors.initials: D
authors.lastname: Ait Ouakrim
authors.affiliation: Department of Biostatistics, International Prevention Research Institute, Lyon, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Pizot
authors.affiliation: Department of Biostatistics, International Prevention Research Institute, Lyon, France.
authors.forename: Magali
authors.initials: M
authors.lastname: Boniol
authors.affiliation: Department of Clinical Sciences and Community Health, Universitá degli Studi di Milano, Milan, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Malvezzi
authors.affiliation: Department of Biostatistics, International Prevention Research Institute, Lyon, France University of Strathclyde Institute for Global Public Health at iPRI, Lyon, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Boniol
authors.affiliation: Department of Epidemiology, IRCCS (Istituto di Ricerche Farmacologiche Mario Negri), Milan, Italy.
authors.forename: Eva
authors.initials: E
authors.lastname: Negri
authors.affiliation: Department of Biostatistics, International Prevention Research Institute, Lyon, France University of Strathclyde Institute for Global Public Health at iPRI, Lyon, France.
authors.forename: Maria
authors.initials: M
authors.lastname: Bota
authors.affiliation: Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Jenkins
authors.affiliation: Jules Bordet Institute, Brussels, Belgium.
authors.forename: Harry
authors.initials: H
authors.lastname: Bleiberg
authors.affiliation: University of Strathclyde Institute for Global Public Health at iPRI, Lyon, France Department of Population Research, International Prevention Research Institute, 69006 Lyon Cedex 08, France philippe.autier@i-pri.org.
authors.forename: Philippe
authors.initials: P
authors.lastname: Autier
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000401:mortality*; D016208:Databases, Factual; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D012189:Retrospective Studies; D014944:World Health Organization