title: Geographical and Temporal Variations in Female Breast Cancer Mortality in the Municipalities of Andalusia (Southern Spain).
abstract: The last published figures have shown geographical variations in mortality with respect to female breast cancer in European countries. However, national health policies need a dynamic image of the geographical variations within the country. The aim of this paper was to describe the spatial distribution of age-specific mortality rates from female breast cancer in the municipalities of Andalusia (southern Spain) and to analyze its evolution over time from 1981 to 2012. An ecological study was devised. Two spatio-temporal hierarchical Bayesian models were estimated. One of these was used to estimate the age-specific mortality rate for each municipality, together with its time trends, and the other was used to estimate the age-specific rate ratio compared with Spain as a whole. The results showed that 98% of the municipalities exhibited a decreasing or a flat mortality trend for all the age groups. In 2012, the geographical variability of the age-specific mortality rates was small, especially for population groups below 65. In addition, more than 96.6% of the municipalities showed an age-specific mortality rate similar to the corresponding rate for Spain, and there were no identified significant clusters. This information will contribute towards a reflection on the past, present and future of breast cancer outcomes in Andalusia.
authors.affiliation: Escuela Andaluza de Salud Pública, Cuesta del Observatorio 4, 18011 Granada, Spain. ricardo.ocana.easp@juntadeandalucia.es.|Instituto de Investigación Biosanitaria de Granada, Doctor Azpitarte 4, 4ª Planta, Edificio Licinio de la Fuente, 18012 Granada, Spain. ricardo.ocana.easp@juntadeandalucia.es.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Ocaña-Riola
authors.affiliation: Servicio de Epidemiología y Salud Laboral, Dirección General de Salud Pública y Ordenación Farmacéutica, Secretaría General de Salud Pública y Consumo, Consejería de Salud de la Junta de Andalucía, Avenida de la Innovación s/n, Edificio Arena 1, 41020 Sevilla, Spain. mariac.montano.sspa@juntadeandalucia.es.
authors.forename: Carmen
authors.initials: C
authors.lastname: Montaño-Remacha
authors.affiliation: Servicio de Epidemiología y Salud Laboral, Dirección General de Salud Pública y Ordenación Farmacéutica, Secretaría General de Salud Pública y Consumo, Consejería de Salud de la Junta de Andalucía, Avenida de la Innovación s/n, Edificio Arena 1, 41020 Sevilla, Spain. josem.mayoral@juntadeandalucia.es.
authors.forename: José María
authors.initials: JM
authors.lastname: Mayoral-Cortés
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001499:Bayes Theorem; D001943:Breast Neoplasms / Q000401:mortality*; D005260:Female; D005843:Geography; D006801:Humans; D008875:Middle Aged; D009026:Mortality; D012621:Seasons; D013030:Spain / Q000453:epidemiology; D055815:Young Adult
keywords: Andalusia; Bayesian analysis; Geographical Information System; Spain; breast cancer; mortality; small areas; spatial statistics; trend analysis