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Male non-lung cancer death epidemics in developing nations: Courses, causation, and cures

Bruce N. Leistikow, MD, MS, Epidemiology and Preventive Medicine, Univ. California - Davis, 1 Shields, Davis, CA 95616, 00000000000, bnleistikow@ucdavis.edu

Background. Male cancer age-adjusted death rates (rates) increased rapidly in many developing nations in recent decades. The absolute increases are generally greater for ~non-lung (all sites except lung and stomach) than lung cancer death rates. The courses, causation, and cures for those epidemics have not been studied. So we assessed male non-lung cancer trends from 1968-1997 in the eleven most populous developing nations with “good quality” death data. Methods. We obtained death rates from the World Health Organization. We modeled male ~non-lung cancer death rates as a function of a) nation and year and b) smoke exposure adjusted for nation and year. We used lung cancer death rates as a smoke exposure measure. Findings. Exposure differences ranged up to -23% to +123% over time within nations and twelve-fold across nations and years. For each 1/100,000 lung cancer death rate difference there was an estimated 1.26 (95% confidence interval 1.21-1.32) /100,000 rate difference in ~non-lung cancer death rates. Adjusted for nation and year, exposure can explain over 60% of the ~non-lung cancer death rates variance (p<0.0001). Best estimate smoking-attributable fractions of recent male all-sites cancer death rates ranged from 15% (sensitivity range 0 – 36%) for Venezuela to 45% (sensitivity range 36 – 50%) globally to 73% (sensitivity range 62 – 80%) for Hungary.

Interpretation. Very strong smoke exposure/non-lung cancer death rate associations were seen in and across populous developing nations from four continents. Smoking may have caused 45% of the year 2000 male all-sites cancer death rate globally.

Learning Objectives: At the conclusion of the session, the participant (learner) in this session will be able to

Keywords: Tobacco, International Public Health

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

International Tobacco Poster Session

The 132nd Annual Meeting (November 6-10, 2004) of APHA