| Abstract |
Aim: Colorectal cancer (CC) is the second cause of cancer mortality worldwide, according to the International Cancer Registries. Greece lacks systematic and complete cancer data. Nevertheless, the Regional Cancer Registry of Crete (CRC) is an official entity that operates in the island of Crete since 1992 with the aim to collect cancer data and monitor the disease burden.
Method: Data were obtained from the CRC regarding all cases of death from CC for a period of 22 years (1992-2013). Other information was also collected from the electronic database of the CRC, as follows: Gender, age, year of birth, insurance fund, occupation, place of origin, place of residence, cancer diagnosis, date and place of diagnosis, cause of death, second or third cancer diagnosis, comorbidity, family history. The following epidemiological rates and ratios were estimated for the whole Crete, for each county and municipality: Crude Mortality Rates (CMR), Age-specific Mortality Rates (ASpMR), Age-standardized Mortality Rates (ASMR) and Age-standardized Mortality ratios (SMRs). The automatic processes of the CRC’s monitoring system (connected to STATA software and ArcGIS-ArcMap 10.2.2) were utilized to calculate the above rates, illustrate them in graphs and tables and carry out the spatio-temporal analysis (all tests were conducted at a significance level of 0.05). Furthermore, Kappa statistic and Moran's I index were calculated, while spatiotemporal trends and CC hot spots using the Getis Ord G *. A prediction model (co-kriging, interpolation techniques) was then proposed, estimating the expected mortality rates (2014-2022).
Results: For the whole study period of the 22 years (1992-2013), the ASMR/100,000/year maintained a constantly increasing trend. The mean annual mortality (meanASMR) was 5.3/100,000/year [men: 6.8/100,000/year and women: 4.7/100,000/year]. The average gender ratio was SMRsmale/female = 1.61 (min-max = 0.95-2.18). The lowest average gender ratio out of the four counties was identified
Public Health & Health Care Management
Faculty of Medicine – University of Crete
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in the county of Rethymno (meanSMRsarren/female = 1.7). Heraklion and Rethymno municipalities presented the highest rates per year (meanyearASMR = 5.9-6.4/100,000/year). Spatiotemporal trends [standard deviational ellipse, (1 SD)] varied significantly among the island, presenting a reverse clockwise movement (increasing trend in Lasithi county]. Other SMRs of several parameters’ sub-groups were the following: place of residence (rural/urban = 1.1), insurance (Agricultural insurance/Other = 1.3), occupation (Pensioners/Professionals = 1.3), marital status (Widowed/Married = 1.3), second cancer diagnosis (yes/no = 1.3), comorbidity (yes/no = 1.3). Rethymno and Anogia municipalities presented the most significant hot spots of CC mortality (95% CI). The highest predicted mortality rates (2014-2022) are expected in the municipalities of Kissamos, Sfakia, Rethymno, Anogia, Heraklion, Viannos, Agios Nikolaos, Ierapetra and Sitia (predictedASMR = 7.0-7.5).
Conclusion: CC mortality in Crete has been increased during 1992-2013, verifying the research hypothesis. Future trends indicate further increase and this is probably due to the lifestyle of residents or poor preventive measures. We should therefore examine these causes and take preventive measures to reduce mortality and disease burden.
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Θνησιμότητα από καρκίνο του παχέος εντέρου στην Κρήτη, 1992-2013 : επιδημιολογικοί δείκτες στο χώρο και το χρόνο
