title: Temporal evolution of brain cancer incidence in the municipalities of Navarre and the Basque Country, Spain.
abstract: BACKGROUND
  Brain cancer incidence rates in Spain are below the European's average. However, there are two regions in the north of the country, Navarre and the Basque Country, ranked among the European regions with the highest incidence rates for both males and females. Our objective here was two-fold. Firstly, to describe the temporal evolution of the geographical pattern of brain cancer incidence in Navarre and the Basque Country, and secondly, to look for specific high risk areas (municipalities) within these two regions in the study period (1986-2008).
  
  
  METHODS
  A mixed Poisson model with two levels of spatial effects is used. The model also included two levels of spatial effects (municipalities and local health areas). Model fitting was carried out using penalized quasi-likelihood. High risk regions were detected using upper one-sided confidence intervals.
  
  
  RESULTS
  Results revealed a group of high risk areas surrounding Pamplona, the capital city of Navarre, and a few municipalities with significant high risks in the northern part of the region, specifically in the border between Navarre and the Basque Country (Gipuzkoa). The global temporal trend was found to be increasing. Differences were also observed among specific risk evolutions in certain municipalities.
  
  
  CONCLUSIONS
  Brain cancer incidence in Navarre and the Basque Country (Spain) is still increasing with time. The number of high risk areas within those two regions is also increasing. Our study highlights the need of continuous surveillance of this cancer in the areas of high risk. However, due to the low percentage of cases explained by the known risk factors, primary prevention should be applied as a general recommendation in these populations.
authors.affiliation: Department of Statistics and O.R., Public University of Navarre, Campus de Arrosadía, Pamplona, 31006, Spain. lola@unavarra.es.|Institute for Advanced Materials (INAMAT), Public University of Navarre, Campus de Arrosadía, Pamplona, 31006, Spain. lola@unavarra.es.
authors.forename: María Dolores
authors.initials: MD
authors.lastname: Ugarte
authors.affiliation: Department of Statistics and O.R., Public University of Navarre, Campus de Arrosadía, Pamplona, 31006, Spain. aritz.adin@unavarra.es.|Institute for Advanced Materials (INAMAT), Public University of Navarre, Campus de Arrosadía, Pamplona, 31006, Spain. aritz.adin@unavarra.es.
authors.forename: Aritz
authors.initials: A
authors.lastname: Adin
authors.affiliation: Department of Statistics and O.R., Public University of Navarre, Campus de Arrosadía, Pamplona, 31006, Spain. tomas.goicoa@unavarra.es.|Institute for Advanced Materials (INAMAT), Public University of Navarre, Campus de Arrosadía, Pamplona, 31006, Spain. tomas.goicoa@unavarra.es.|Research Network on Health Services in Chronic Diseases (REDISSEC), Madrid, Spain. tomas.goicoa@unavarra.es.
authors.forename: Tomás
authors.initials: T
authors.lastname: Goicoa
authors.affiliation: Navarre Public Health Institute, Calle Leyre 15, Pamplona, 31006, Spain. mi.casado.buesa@navarra.es.
authors.forename: Itziar
authors.initials: I
authors.lastname: Casado
authors.affiliation: Navarre Public Health Institute, Calle Leyre 15, Pamplona, 31006, Spain. me.ardanaz.aicua@cfnavarra.es.|CIBER of Epidemiology an Public Health CIBERESP, Madrid, Spain. me.ardanaz.aicua@cfnavarra.es.
authors.forename: Eva
authors.initials: E
authors.lastname: Ardanaz
authors.affiliation: CIBER of Epidemiology an Public Health CIBERESP, Madrid, Spain. epidem3-san@euskadi.eus.|Public Health Division of Gipuzkoa, BIODonostia Research Institute, Government of the Basque Country, Nafarroa hiribidea 4, Donostia-San Sebastián, 20013, Spain. epidem3-san@euskadi.eus.
authors.forename: Nerea
authors.initials: N
authors.lastname: Larrañaga
mesh_terms: D001932:Brain Neoplasms / Q000453:epidemiology*; D002947:Cities; D005006:Ethnicity; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D062211:Spatio-Temporal Analysis; D014505:Urban Population / Q000706:statistics & numerical data*; D044465:White People