Lung cancer mortality trends in different urban settings in Brazil, 2000-2015

this was a time series study; lung cancer death records were corrected; linear autoregressive models were used to calculate regression coefficients (β₁) and 95% confidence intervals (95%CI) in trend analysis according to sex, in the 30 and over age group, for 19 metropolitan areas (MAs) and the interior regions of 14 Brazilian states; positive β₁ indicates upward trends while negative β₁ indicates downward trends.

Results:

increases were found in males from interior regions of North and Northeastern Brazilian states, especially in Rio Grande do Norte state (β₁=1.03 - 95%CI0.47;1.58); downward trends were also found in males, notably in the Porto Alegre MA (β₁=-2.55 - 95%CI-2.79;-2.31); the highest increase in females was found in the interior of Ceará state (β₁=0.86 - 95%CI0.79;0.92).

Conclusion:

differentiated patterns according to location and sex were revealed; cancer control measures should be considered above all for women and the interior regions of Brazil.

Keywords:
Lung Neoplasms; Mortality; Time Series Studies; Mortality Registries; Urban Area

Geographic unit Interior of FU^a and corresponding MA^b	Standardized mortality coefficient (per 100,000 inhabitants)
	Males
	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015
Amazonas	17.7	16.0	13.1	11.9	19.3	14.4	13.6	22.6	19.4	16.7	17.4	19.9	19.3	20.9	29.0	21.4
Manaus MA	60.6	53.2	62.9	56.7	57.2	57.9	45.3	45.0	55.5	51.3	38.3	52.5	55.4	45.8	47.5	45.1
Bahia	8.4	11.7	9.4	10.1	10.7	11.1	13.6	14.4	14.4	15.4	13.8	14.0	15.4	14.8	15.9	16.3
Salvador MA	45.0	47.4	43.4	45.3	41.4	44.6	39.8	43.6	39.2	44.3	40.2	40.0	33.9	33.9	37.4	35.6
Ceará	12.5	14.8	15.7	19.0	17.1	19.8	19.5	22.8	19.9	19.6	23.7	24.6	21.9	25.2	25.1	26.0
Fortaleza MA	34.9	34.5	38.8	38.3	37.2	44.0	38.3	41.2	41.8	44.5	36.5	44.3	49.6	34.7	42.9	44.0
Espírito Santo	30.0	29.3	34.8	32.2	36.6	39.6	34.0	32.5	28.1	33.1	32.9	29.3	30.1	33.0	25.3	29.2
Grande Vitória MA	54.7	51.2	62.6	45.2	54.6	49.4	49.6	44.5	44.8	43.8	45.7	45.4	41.0	47.2	41.3	40.0
Goiás	28.8	36.1	26.5	28.0	34.8	34.1	28.8	32.8	29.4	30.5	31.4	28.8	32.4	35.0	35.6	32.9
Goiânia MA	38.4	42.8	51.1	44.0	48.4	40.5	37.1	46.4	46.1	41.0	41.0	45.3	44.8	46.6	44.0	44.3
Maranhão	4.9	5.9	3.3	8.6	6.9	12.8	11.7	12.0	16.0	15.9	17.0	14.1	15.3	17.4	17.7	20.4
Grande São Luís MA	31.1	42.1	30.7	42.9	39.3	37.7	31.1	35.4	35.6	41.3	35.4	27.8	35.6	45.9	39.9	42.3
Minas Gerais	26.2	26.7	28.3	26.9	27.9	27.2	27.2	26.9	25.8	26.8	29.1	27.6	29.5	27.3	29.1	26.9
Belo Horizonte MA	40.7	44.4	42.5	39.0	35.1	40.6	38.5	38.2	36.5	33.8	33.4	31.5	30.6	33.1	32.1	32.6
Pará	7.2	8.0	6.4	10.7	9.3	8.5	13.6	15.9	18.2	18.1	16.3	14.5	13.2	17.1	17.5	21.2
Belém MA	45.8	64.2	46.7	54.2	46.6	53.8	43.5	39.9	52.0	37.7	37.2	41.8	47.1	35.9	40.0	34.3
Paraná	48.0	48.4	46.0	45.4	46.0	45.7	46.5	46.6	41.5	43.1	43.8	40.2	39.2	39.8	39.2	38.1
Curitiba MA	53.9	56.7	58.3	61.5	54.1	45.9	43.4	44.8	47.1	45.9	45.5	44.9	40.2	44.1	41.4	38.5
Pernambuco	12.5	11.8	13.1	14.3	16.5	19.1	18.2	17.8	21.4	19.9	20.4	20.3	21.6	25.4	23.2	23.3
Recife MA	56.3	47.5	48.5	42.2	49.0	46.4	48.3	43.9	42.4	33.8	44.7	43.9	43.4	43.9	42.5	40.7
Rio de Janeiro	50.6	46.9	47.1	47.1	45.5	43.1	42.8	44.6	41.3	39.2	38.5	37.3	38.7	40.4	35.6	36.4
Rio de Janeiro MA	68.4	65.7	66.2	59.7	65.1	56.2	53.9	52.4	51.6	48.3	49.6	45.3	44.9	42.2	38.5	37.2
Rio Grande do Norte	6.8	9.1	13.6	14.6	22.0	25.1	21.1	19.6	22.9	22.9	16.7	24.9	24.2	20.9	25.6	25.7
Natal MA	26.4	22.5	32.2	39.1	47.7	44.4	30.8	34.0	35.8	29.3	35.3	29.9	28	37.2	32.2	32.2
Rio Grande do Sul	95.5	87.8	89.1	90.5	88.0	88.9	78.5	80.6	79.7	72.1	74.2	68.6	70.1	67.7	66.7	64.3
Porto Alegre MA	109.6	105.0	102.0	102.0	106.0	92.6	93.8	91.8	90.2	89.6	86.1	81.4	75.0	76.9	69.8	74.3
São Paulo	49.0	49.2	50.3	49.3	46.4	44.9	42.7	41.2	42.8	40.3	37.6	37.8	38.4	37.2	36.3	35.5
São Paulo MA	64.0	62.1	60.8	60.2	55.9	50.8	49.6	49.0	47.2	46.9	43.5	42.1	41.5	41.6	38.1	38.5
Federal District RIDE^c	47.9	49.5	40.3	37.6	39.6	48.2	40.3	41.1	35.2	38.0	42.4	31.6	37.0	38.5	32.9	32.0
Baixada Santista MA^c	54.3	62.4	67.8	57.2	60.2	55.7	52.0	54.0	50.7	47.6	47.0	46.6	42.1	45.6	44.6	38.3
Campinas MA^c	55.4	48.1	44.3	54.7	55.6	50.3	39.6	39.8	43.9	46.4	40.4	35.7	34.1	37.8	37.5	34.5
Sorocaba MA^c	48.8	45.7	49.2	45.5	47.2	49.5	38.1	38.9	42.2	36.3	38.0	33.1	34.1	35.4	34.6	29.5
Vale do Paraíba and Litoral Norte MA^c	47.7	48.3	42.3	45.9	39.9	38.3	39.6	40.6	32.1	39.4	31.8	30.0	27.4	31.7	33.0	32.9
Geographic unit Interior of FU^a and corresponding MA^b	Standardized mortality coefficient (per 100,000 inhabitants)
	Females
	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015
Amazonas	7.8	9.0	6.5	7.7	3.1	11.3	8.2	7.5	7.4	8.2	10.4	7.4	11.5	11.2	13.6	11.1
Manaus MA	27.0	29.6	25.5	27.3	28.2	28.0	30.4	27.9	29.9	25.2	20.4	27.6	28.9	30.2	24.6	28.2
Bahia	4.1	4.5	5.8	5.3	5.3	5.3	7.6	5.6	7.8	8.3	7.4	8.7	8.7	9.4	9.9	9.8
Salvador MA	16.1	12.4	18.6	17.9	17.2	18.2	16.9	15.6	16.2	18.5	17.4	18.6	17.0	16.1	20.1	16.8
Ceará	7.5	9.2	9.6	10.1	12.0	11.4	13.2	12.8	14.8	15.6	18.7	15.9	18.7	17.5	19.9	21.7
Fortaleza MA	16.8	18.8	18.6	19.8	15.3	21.8	21.1	25.1	24.5	24.1	23.8	24.4	27.6	30.5	25.4	27.2
Espírito Santo	11.0	11.3	11.2	15.6	13.5	14.6	13.4	11.8	12.5	14.6	15.0	16.0	14.9	15.2	13.9	15.3
Grande Vitória MA	17.5	21.6	19.0	24.0	21.9	18.4	18.7	22.0	19.5	21.2	17.4	17.8	17.7	21.2	20.4	16.6
Goiás	21.6	20.3	17.6	18.4	20.8	18.7	19.0	19.2	18.7	21.4	17.9	18.1	22	21.4	22.5	22.0
Goiânia MA	24.1	20.3	25.1	19.9	27.1	17.4	21.9	23.9	21.4	22.8	23.4	23.2	26.8	22.2	29.9	24.0
Maranhão	2.1	2.4	4.2	3.4	3.9	5.7	6.1	7.0	8.3	8.9	9.1	9.7	9.6	9.3	11.3	12.2
Grande São Luís MA	11.1	18.4	16.4	11.9	16.1	15.3	13.7	17.7	11.0	16.2	15.4	13.1	17.0	20.3	17.2	22.8
Minas Gerais	11.6	11.2	11.4	12.1	12.8	11.9	12.8	13.8	12.6	12.8	13.2	13.8	13.7	14.7	14.9	15.0
Belo Horizonte MA	15.8	14.1	12.4	16.3	14.1	15.1	14.4	13.3	14.7	13.4	13.9	15.0	15.3	15.2	14.2	18.3
Pará	2.9	4.6	2.5	6.3	4.0	6.4	7.3	6.9	8.7	10.5	6.9	7.2	8.2	6.9	9.7	12.3
Belém MA	19.6	30.8	17.0	23.0	14.1	14.1	19.2	22.1	16.1	19.4	14.5	19.4	21.5	18.4	17.5	17.0
Paraná	21.8	21.2	21.5	21.7	22.2	20.8	18.7	21.0	22.6	21.5	22.5	23.5	22.6	21.4	20.5	23.2
Curitiba MA	26.2	25.7	25.5	24.0	25.7	22.9	26.0	22.2	28.3	23.3	22.9	22.4	21.3	25.9	23.8	25.8
Pernambuco	7.6	6.4	8.1	6.8	9.7	9.0	11.4	13.7	12.5	12.5	12.3	13.1	15.5	15.5	14.7	15.3
Recife MA	14.0	16.8	13.5	17.7	16.2	21.5	17.7	17.2	19.6	18.7	19.9	18.9	16.2	18.4	20.5	20.0
Rio de Janeiro	17.3	15.6	18.6	15.9	15.9	16.2	17.3	16.8	18.7	18.5	17.8	18.0	19.4	19.5	18.6	18.8
Rio de Janeiro MA	21.5	19.0	20.8	21.3	22.9	21.9	20.5	20.6	21.5	22.1	22.2	20.9	21.2	21.6	21.9	21.8
Rio Grande do Norte	6.9	9.2	8.1	11.4	9.1	13.4	12.2	14.4	13.1	13.0	13.8	17.4	14.1	19.0	16.8	16.2
Natal MA	10.6	15.8	17.3	16.1	19.1	15.1	16.8	18.0	18.8	18.6	16.9	20.1	16.5	16.6	19.7	23.1
Rio Grande do Sul	26.7	25.2	24.3	27.2	26.6	28.7	24.9	27.3	26.7	27.9	26.9	30.7	28.2	28.8	30.3	30.4
Porto Alegre MA	31.4	34.7	30.9	31.1	29.9	31.8	36.9	36.2	35.2	34.9	37.1	34.9	38.7	35.6	35.4	36.1
São Paulo	16.6	17.2	17.1	18.0	17.1	17.4	18.4	18.9	17.2	18.1	18.4	19.0	19.5	20.1	19.1	20.2
São Paulo MA	22.2	21.0	19.4	20.9	20.6	20.1	21.1	21.3	21.4	21.0	21.2	21.4	20.6	20.1	20.7	21.9
Federal District RIDE^c	18.0	19.7	18.5	14.5	20.0	15.1	23.8	15.9	18.3	15.1	17.7	18.4	20.9	19.4	20.8	18.2
Baixada Santista MA^c	19.8	20.3	18.0	22.3	27.1	20.9	20.4	24.2	28.9	22.0	25.7	23.1	26.1	21.0	26.8	25.8
Campinas MA^c	15.6	15.8	16.7	17.5	17.8	18.7	15.1	15.9	19.3	15.4	16.2	16.7	15.8	20.0	15.9	18.9
Sorocaba MA^c	17.8	15.5	17.3	20.5	20.7	18.9	17.8	20.8	21.4	14.8	17.0	16.5	15.0	15.1	22.3	21.5
Vale do Paraíba and Litoral Norte MA^c	13.7	16.9	19.3	14.1	17.2	16.2	15.9	17.5	18.2	18.6	19.9	17.9	17.0	16.3	20.6	20.1

Geographic unit		Males			Females
Geographic unit		Beta	Lower limit	Upper limit	Beta	Lower limit	Upper limit
State interior region	Amazonas except Manaus MA	0.61	0.32	0.90	0.33	0.17	0.50
	Bahia except Salvador MA	0.48	0.35	0.60	0.39	0.35	0.43
	Ceará except Fortaleza MA	0.78	0.65	0.91	0.86	0.79	0.92
	Espírito Santo except Grande Vitória MA	-0.27	-0.66	0.12	0.24	0.09	0.39
	Goiás except Goiânia MA	0.19	-0.07	0.45	0.13	-0.05	0.31
	Maranhão except Grande São Luís MA	1.01	0.81	1.21	0.66	0.58	0.74
	Minas Gerais except Belo Horizonte MA	0.09	0.01	0.17	0.24	0.19	0.28
	Pará except Belém MA	0.86	0.52	1.20	0.46	0.30	0.62
	Paraná except Curitiba MA	-0.67	-0.81	-0.54	0.07	-0.07	0.21
	Pernambuco except Recife MA	0.81	0.65	0.96	0.62	0.50	0.75
	Rio de Janeiro except Rio de Janeiro MA	-0.89	-1.04	-0.74	0.20	0.12	0.28
	Rio Grande do Norte except Natal MA	1.03	0.47	1.58	0.66	0.57	0.75
	Rio Grande do Sul except Porto Alegre MA	-2.04	-2.27	-1.82	0.31	0.22	0.40
	São Paulo except São Paulo MA	-1.02	-1.21	-0.83	0.21	0.15	0.26
Metropolitan Area (MA)	Federal District RIDE	-0.84	-1.19	-0.49	0.10	-0.06	0.27
	Baixada Santista MA	-1.51	-1.82	-1.19	0.36	0.13	0.59
	Belém MA	-1.23	-1.55	-0.91	-0.26	-0.61	0.08
	Belo Horizonte MA	-0.78	-1.01	-0.55	0.08	-0.02	0.17
	Campinas MA	-1.30	-1.82	-0.77	0.07	-0.04	0.18
	Curitiba MA	-1.17	-1.70	-0.65	-0.12	-0.26	0.01
	Sorocaba MA	-1.24	-1.48	-1.00	0.06	-0.28	0.40
	Vale do Paraíba and Litoral Norte MA	-1.20	-1.51	-0.90	0.24	0.09	0.39
	Fortaleza MA	0.48	0.20	0.75	0.78	0.59	0.96
	Goiânia MA	0.08	-0.30	0.46	0.27	0.12	0.42
	Grande São Luís MA	0.25	-0.24	0.73	0.30	0.06	0.55
	Grande Vitória MA	-0.96	-1.19	-0.74	-0.14	-0.32	0.04
	Manaus MA	-0.89	-1.38	-0.40	-0.05	-0.32	0.21
	Natal MA	0.09	-0.84	1.02	0.37	0.14	0.60
	Porto Alegre MA	-2.55	-2.79	-2.31	0.37	0.15	0.59
	Recife MA	-0.63	-1.02	-0.24	0.28	0.12	0.44
	Rio de Janeiro MA	-2.07	-2.20	-1.94	0.06	-0.03	0.16
	Salvador MA	-0.75	-0.93	-0.57	0.13	0.00	0.27
	São Paulo MA	-1.76	-2.03	-1.48	0.01	-0.07	0.09

Secretaria de Vigilância em Saúde e Ambiente - Ministério da Saúde do Brasil SRTVN Quadra 701, Via W5 Norte, Lote D, Edifício P0700, CEP: 70719-040, +55 61 3315-3464, Fax: +55 61 3315-3464 - Brasília - DF - Brazil
E-mail: ress.svs@gmail.com

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[1] Correspondence: Gustavo dos Santos Souza - SQSW 304, Bloco C, Apto. 414, Residencial Tiffany, Setor Sudoeste, Brasília, DF, Brazil. Postcode: 70673-406 E-mail: gustavosas@hotmail.com