title: Recent lung cancer mortality trends in Europe: effect of national smoke-free legislation strengthening.
abstract: The impact of smoke-free legislation within European Union (EU) countries on lung cancer mortality has not been evaluated to date. We aimed to determine lung cancer mortality trends in the EU-27 by sex, age, and calendar year for the period of 1994 and 2012, and relate them with changes in tobacco legislation at the national level. Deaths by Eurostat in each European country were analyzed, focusing on ICD-10 codes C33 and C34 from the years 1994 to 2012. Age-standardized mortality rates (ASR) were estimated separately for women and men in the EU-27 total and within country for each one of the years studied, and the significance of changing trends was estimated by joinpoint regression analysis, exploring lag times after initiation of smoke-free legislation in every country, if any. From 1994 to 2012, there were 4 681 877 deaths from lung cancer in Europe (3 491 607 in men and 1 190 180 in women) and a nearly linear decrease in mortality rates because of lung cancer in men from was observed1994 to 2012, mirrored in women by an upward trend, narrowing the sex gap during the study period from 5.1 in 1994 to 2.8 in 2012. Joinpoint regression analysis identified a number of trend changes over time, but it appears that they were unrelated to the implementation of smoke-free legislations. A few years after the introduction of smoke-free legislations across Europe, trends of lung cancer mortality trends have not changed.
authors.affiliation: Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocio, Universidad de Sevilla.|CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III.
authors.forename: Jose L
authors.initials: JL
authors.lastname: López-Campos
authors.affiliation: Consejería de Salud de Andalucía, Seville.
authors.forename: Miguel
authors.initials: M
authors.lastname: Ruiz-Ramos
authors.affiliation: Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia.|Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Esteve
authors.initials: E
authors.lastname: Fernandez
authors.affiliation: Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Madrid.
authors.forename: Joan B
authors.initials: JB
authors.lastname: Soriano
mesh_terms: D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000453:epidemiology* / Q000401:mortality*; D008297:Male; D009026:Mortality / Q000639:trends*; D011379:Prognosis; D061845:Smoke-Free Policy / Q000331:legislation & jurisprudence*; D012907:Smoking / Q000009:adverse effects; D015996:Survival Rate