ESOPHAGEAL CANCER MORTALITY IN BRAZIL: A TIME-SERIES ANALYSIS FROM THE GLOBAL BURDEN OF DISEASE STUDY

OLIVEIRA, Max Moura de; SILVA, Igor Pereira Bertoncini; TEIXEIRA, Renato; MALTA, Deborah Carvalho; ISER, Betine Pinto Moehlecke

doi:10.1590/S0004-2803.202100000-17

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ORIGINAL ARTICLE • Arq. Gastroenterol. 58 (01) • Jan-Mar 2021 • https://doi.org/10.1590/S0004-2803.202100000-17 copy

ESOPHAGEAL CANCER MORTALITY IN BRAZIL: A TIME-SERIES ANALYSIS FROM THE GLOBAL BURDEN OF DISEASE STUDY

Mortalidade por câncer de esôfago no Brasil: uma análise de série temporal a partir do estudo da carga global de doenças

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

BACKGROUND:

In the world, around 450,000 new cases of esophageal cancer are diagnosed each year.

OBJECTIVE:

To evaluate the trend of esophageal cancer mortality rates in Brazil between 1990-2017.

METHODS:

A time series study using data on mortality from esophageal cancer in residents ≥30 years in Brazil from 1990 to 2017. Data was estimated by the Global Burden of Disease (GBD) study and analyzed according to sex, age group and federal unit of Brazil. The standardized rates according to age were calculated by the direct method using the standard GBD world population. Annual average percentage change and 95% confidence interval (95% CI) were calculated for mortality by Joinpoint regression.

RESULTS:

The age-standardized mortality rate in males was 20.6 in 1990 and 17.6/100,000 in 2017, increasing according to age, being 62.4 (1990) and 54.7 (2017) for ≥70 years. In women, the age-standardized mortality rate was 5.9 in 1990 and 4.2/100,000 in 2017. There was a reduction in mortality rates in all age groups and both sexes with great variation among the states.

CONCLUSION:

Despite the high mortality rates for esophageal cancer in Brazil, the trend was decreasing, but with regional differences. Mortality was around four times higher in men.

HEADINGS:
Esophageal neoplasms; Global burden of disease; Mortality; Epidemiological studies

Population	30-49 years old			50-69 years old			70+ years old			30+ years old
	Rate		AAPC	Rate		AAPC	Rate		AAPC	Rate		AAPC
	1990	2017	(95% CI)	1990	2017	(95% CI)	1990	2017	(95% CI)	1990	2017	(95% CI)
Acre	1.5	1.6	0.1 (-0.4;0.7)	12.4	12.4	-0.1 (-0.6;0.5)	25.4	29.3	*0.5 (0.3;0.7)**	8.6	8.8	0.0 (-0.3;0.4)
Alagoas	1.8	1.9	0.2 (-0.3;0.6)	11.5	15.1	*0.9 (0.4;1.4)**	25.7	30.1	*0.7 (0.2;1.2)**	8.3	9.9	*0.6 (0.3;1.0)**
Amapá	1.2	1.6	*1.1 (0.8;1.3)**	11.1	13.2	*0.6 (0.4;0.8)**	26.2	32.3	*0.8 (0.6;1.0)**	8.0	9.6	*0.7 (0.5;0.9)**
Amazonas	1.5	1.4	-0.1 (-0.6;0.4)	12.5	13.2	0.2 (-0.1;0.6)	29.0	31.8	0.5 (-0.3;1.4)	9.0	9.3	0.2 (-0.2;0.6)
Bahia	2.1	3.3	*1.7 (1.2;2.2)**	16.8	28.1	*1.9 (1.7;2.0)**	35.7	52.6	*1.4 (0.9;1.9)**	11.4	17.8	*1.7 (1.4;1.9)**
Ceará	2.1	2.4	*0.6 (0.2;1.0)**	17.6	21.4	0.8 (-0.0;1.6)	35.9	50.2	*1.3 (0.9;1.7)**	11.5	14.7	*1.0 (0.5;1.4)**
Distrito Federal	2.6	2.0	*-1.0 (-1.8;-0.3)**	23.5	18.1	*-0.9 (-1.7;-0.2)**	56.2	52.1	-0.3 (-1.1;0.5)	18.2	14.9	*-0.8 (-1.5;-0.1)**
Espírito Santo	3.7	4.6	0.7 (-0.4;1.9)	37.0	36.0	-0.1 (-0.6;0.3)	83.8	71.8	-0.6 (-1.4;0.1)	26.9	23.6	*-0.5 (-0.9;-0.1)**
Goiás	2.4	2.3	-0.2 (-1.0;0.6)	20.2	19.3	-0.2 (-0.7;0.3)	39.7	40.2	0.0 (-0.8;0.8)	13.5	12.8	-0.2 (-0.8;0.3)
Maranhão	1.5	1.0	*-1.7 (-2.3;-1.1)**	8.8	8.3	-0.2 (-1.1;0.6)	14.6	19.1	*1.2 (0.4;2.1)**	5.8	5.7	0.0 (-0.9;1.0)
Mato Grosso	2.2	2.5	*0.5 (0.2;0.8)**	20.6	21.2	0.1 (-0.4;0.6)	41.8	44.0	0.2 (-0.3;0.7)	14.0	14.2	0.0 (-0.4;0.5)
Mato Grosso do Sul	2.9	3.4	0.6 (-0.3;1.6)	23.3	28.2	*0.8 (0.1;1.4)**	55.7	56.9	-0.1 (-0.4;0.2)	17.2	18.5	0.4 (-0.3;1.0)
Minas Gerais	4.0	5.0	*0.7 (0.0;1.5)**	36.7	35.7	-0.3 (-0.9;0.4)	78.8	68.0	*-0.6 (-1.0;-0.1)**	25.4	23.0	-0.5 (-1.1;0.1)
Pará	1.2	1.3	0.3 (-0.5;1.0)	11.2	12.4	0.5 (-0.4;1.3)	26.6	29.2	0.3 (-0.3;0.9)	8.0	8.6	0.3 (-0.4;1.0)
Paraíba	2.0	2.5	*0.8 (0.4;1.1)**	15.6	19.1	*0.8 (0.3;1.2)**	37.9	40.3	0.2 (-0.4;0.8)	11.1	12.8	0.6 (-0.0;1.1)
Paraná	4.4	4.0	-0.4 (-1.0;0.2)	46.0	34.0	*-1.1 (-1.4;-0.8)**	105.5	75.4	*-1.2 (-1.6;-0.9)**	32.7	23.0	*-1.3 (-1.7;-0.8)**
Pernambuco	1.6	2.3	*1.4 (0.9;1.9)**	14.1	19.8	*1.3 (0.8;1.7)**	32.2	44.5	*1.2 (0.7;1.7)**	10.1	13.5	*1.1 (0.6;1.6)**
Piauí	1.4	1.9	*1.0 (0.4;1.6)**	11.4	13.9	0.8 (-0.2;1.8)	26.7	27.7	0.1 (-0.7;1.0)	8.3	9.1	0.4 (-0.3;1.2)
Rio de Janeiro	3.6	2.9	*-0.9 (-1.5;-0.3)**	30.7	27.1	-0.5 (-1.1;0.2)	63.8	47.5	*-1.0 (-1.5;-0.5)**	21.2	16.5	*-0.9 (-1.4;-0.4)**
Rio Grande do Norte	1.7	2.6	*1.6 (1.0;2.2)**	12.4	20.3	*1.9 (0.8;3.0)**	31.9	45.8	*1.3 (0.3;2.3)**	9.1	14.0	*1.5 (1.0;2.1)**
Rio Grande do Sul	6.1	5.1	-0.6 (-1.2;0.0)	61.1	42.9	-0.6 (-1.2;0.0)	135.3	99.4	*-1.1 (-1.5;-0.8)**	42.9	29.5	*-1.4 (-1.6;-1.1)**
Rondônia	2.7	2.4	-0.4 (-1.4;0.6)	22.9	19.5	*-0.6 (-1.0;-0.2)**	49.6	47.2	-0.0 (-0.6;0.5)	16.8	14.0	*-0.6 (-1.1;-0.1)**
Roraima	1.5	1.5	0.1 (-0.5;0.7)	14.1	12.5	*-0.4 (-0.6;-0.2)**	31.1	32.1	0.1 (-0.3;0.4)	10.5	9.5	*-0.4 (-0.7;-0.1)**
Santa Catarina	4.1	3.8	-0.3 (-1.3;0.7)	50.5	33.1	*-1.6 (-2.0;-1.2)**	115.6	79.4	*-1.5 (-1.8;-1.1)**	35.5	23.4	*-1.5 (-2.1;-1.0)**
São Paulo	3.8	2.7	*-1.3 (-1.8;-0.8)**	36.2	28.4	*-1.3 (-1.8;-0.8)**	71.9	51.0	*-1.2 (-1.6;-0.8)**	24.4	17.4	*-1.2 (-1.5;-0.9)**
Sergipe	1.5	2.2	*1.3 (0.3;2.3)**	11.4	15.6	*1.3 (0.7;2.0)**	28.2	31.1	0.4 (-0.3;1.1)	8.3	10.4	*0.9 (0.0;1.7)**
Tocantins	1.4	1.6	*0.7 (0.4;0.9)**	10.5	11.3	0.2 (-0.2;0.6)	20.2	24.9	*0.8 (0.3;1.3)**	7.5	7.8	0.2 (-0.1;0.4)
Brazil	3.3	3.0	*-0.3 (-0.6;-0.1)**	30.9	27.2	*-0.4 (-0.6;-0.3)**	62.4	54.7	*-0.5 (-0.7;-0.2)**	20.6	17.6	*-0.6 (-0.8;-0.3)**

Population	30-49 years old			50-69 years old			70+ years old			30+ years old
	Rate		AAPC	Rate		AAPC	Rate		AAPC	Rate		AAPC
	1990	2017	(95% CI)	1990	2017	(95% CI)	1990	2017	(95% CI)	1990	2017	(95% CI)
Acre	0.3	0.2	*-0.5 (-0.7;-0.2)**	2.6	2.1	-0.9* (-1.2;-0.5)	8.1	7.7	-0.2 (-0.7;0.4)	2.2	1.8	*-0.7 (-1.1;-0.2)**
Alagoas	0.4	0.4	-0.3 (-1.4;0.7)	3.3	3.3	0.0 (-0.4;0.5)	11.6	11.3	-0.1 (-0.7;0.5)	2.8	2.7	-0.1 (-0.6;0.4)
Amapá	0.3	0.3	-0.1 (-0.7;0.6)	3.2	3.0	-0.2 (-0.4;0.1)	11.4	9.6	*-0.7 (-1.0;-0.5)**	2.9	2.4	*-0.7 (-0.8;-0.5)**
Amazonas	0.3	0.3	-0.5 (-1.5;0.4)	3.3	2.6	*-0.9 (-1.1;-0.6)**	11.3	9.9	-0.4 (-1.1;0.2)	2.8	2.3	*-0.7 (-1.3;-0.2)**
Bahia	0.5	0.6	0.4 (-0.4;1.2)	4.5	5.0	*0.4 (0.1;0.7)**	15.1	14.4	-0.2 (-0.6;0.1)	3.7	3.7	-0.0 (-0.2;0.2)
Ceará	0.5	0.5	0.0 (-0.8;0.9)	4.2	5.4	*1.1 (0.7;1.6)**	17.7	20.5	*0.7 (0.1;1.3)**	3.9	4.6	*0.7 (0.0;1.4)**
Distrito Federal	0.6	0.4	*-1.8 (-2.4;-1.3)**	5.9	3.2	*-2.3 (-2.7;-1.9)**	21.6	14.6	*-1.4 (-1.8;-1.0)**	5.8	3.4	*-1.9 (-2.1;-1.8)**
Espírito Santo	1.0	0.8	*-0.8 (-1.4;-0.2)**	8.8	6.7	*-1.0 (-1.3;-0.7)**	32.9	24.2	*-1.2 (-1.7;-0.7)**	8.5	5.6	*-1.5 (-1.9;-1.1)**
Goiás	0.6	0.5	*-0.8 (-1.1;-0.6)**	5.5	4.4	*-0.8 (-1.3;-0.3)**	21.1	14.0	*-1.4 (-1.9;-0.9)**	5.6	3.5	*-1.6 (-2.1;-1.1)**
Maranhão	0.3	0.2	-0.5 (-1.2;0.2)	1.8	1.9	0.1 (-0.3;0.6)	6.2	5.5	-0.4 (-1.0;0.3)	1.6	1.4	-0.2 (-0.8;0.4)
Mato Grosso	0.5	0.5	-0.4 (-1.0;0.1)	4.9	4.0	*-0.8 (-1.3;-0.3)**	16.3	14.2	-0.5 (-1.2;0.2)	4.2	3.4	*-0.7 (-1.2;-0.2)**
Mato Grosso do Sul	0.7	0.6	-0.1 (-0.5;0.3)	6.6	5.0	*-1.0 (-1.6;-0.5)**	21.9	18.4	*-0.6 (-1.2;-0.0)**	5.8	4.3	*-1.0 (-1.6;-0.5)**
Minas Gerais	1.0	1.0	0.0 (-0.6;0.6)	10.0	7.0	*-1.3 (-1.8;-0.9)**	33.5	24.0	*-1.3 (-1.6;-0.9)**	8.6	5.7	*-1.6 (-1.9;-1.2)**
Pará	0.4	0.3	*-1.0 (-1.3;-0.6)**	3.0	2.4	*-0.8 (-1.3;-0.3)**	11.5	8.9	*-0.9 (-1.1;-0.6)**	2.7	2.1	*-0.9 (-1.1;-0.7)**
Paraíba	0.6	0.5	*-0.7 (-1.4;-0.1)**	4.9	4.2	*-0.5 (-0.8;-0.2)**	19.7	16.4	*-0.8 (-1.5;-0.1)**	4.5	3.6	*-0.8 (-1.5;-0.1)**
Paraná	1.1	0.8	*-1.3 (-2.2;-0.4)**	12.4	7.2	*-2.0 (-2.3;-1.6)**	40.2	25.5	*-1.6 (-2.0;-1.3)**	10.5	6.0	*-2.0 (-2.4;-1.7)**
Pernambuco	0.6	0.5	-0.4 (-1.1;0.3)	4.4	4.5	0.1 (-0.6;0.8)	15.1	17.3	0.6 (-0.1;1.4)	3.9	3.9	0.0 (-0.4;0.4)
Piauí	0.4	0.3	0.0 (-0.9;0.9)	3.0	3.2	0.4 (-0.5;1.3)	9.9	10.2	0.2 (-0.5;0.9)	2.5	2.5	0.2 (-0.4;0.9)
Rio de Janeiro	0.7	0.5	*-1.2 (-1.8;-0.7)**	7.3	5.0	*-1.4 (-1.8;-1.0)**	23.5	15.0	*-1.6 (-2.3;-0.9)**	6.0	3.7	*-1.7 (-2.3;-1.2)**
Rio Grande do Norte	0.4	0.5	0.4 (-0.0;0.9)	3.7	4.0	0.2 (-0.2;0.7)	13.4	14.6	0.3 (-0.2;0.8)	3.1	3.4	0.2 (-0.2;0.6)
Rio Grande do Sul	1.2	1.1	-0.2 (-1.3;0.9)	14.0	10.1	*-1.2 (-1.8;-0.6)**	51.5	35.2	*-1.4 (-1.9;-0.8)**	12.4	8.2	*-1.5 (-1.9;-1.1)**
Rondônia	0.6	0.5	*-1.0 (-1.5;-0.5)**	5.9	4.0	*-1.4 (-1.7;-1.1)**	18.7	16.4	*-0.5 (-0.8;-0.2)**	5.3	3.8	*-1.3 (-1.7;-0.9)**
Roraima	0.4	0.3	*-0.9 (-1.6;-0.2)**	4.1	3.0	*-1.1 (-1.5;-0.8)**	14.0	12.3	*-0.5 (-0.7;-0.2)**	4.0	3.0	*-1.1 (-1.3;-0.8)**
Santa Catarina	0.8	0.6	*-0.7 (-1.4;-0.0)**	8.4	5.7	*-1.4 (-2.3;-0.4)**	32.6	22.4	*-1.5 (-1.6;-1.4)**	7.9	5.1	*-1.5 (-2.3;-0.8)**
São Paulo	0.6	0.5	*-0.9 (-1.1;-0.7)**	6.1	4.3	*-1.3 (-1.7;-0.9)**	20.8	13.3	*-1.6 (-2.3;-0.9)**	5.3	3.3	*-1.7 (-2.2;-1.2)**
Sergipe	0.4	0.4	-0.6 (-1.5;0.4)	3.7	3.1	-0.5 (-1.1;0.0)	14.4	11.5	*-0.8 (-1.3;-0.3)**	3.2	2.7	*-0.7 (-1.2;-0.2)**
Tocantins	0.4	0.4	-0.1 (-1.0;0.8)	3.5	3.2	-0.4 (-0.9;0.1)	12.3	11.3	-0.4 (-0.7;0.0)	3.5	2.7	*-0.9 (-1.1;-0.7)**
Brasil	0.7	0.6	*-0.7 (-1.1;-0.3)**	7.0	5.2	*-1.1 (-1.4;-0.8)**	24.0	17.7	*-1.1 (-1.5;-0.7)**	5.9	4.2	*-1.2 (-1.6;-0.8)**

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[1] Corresponding author: Max Moura de Oliveira. E-mail: maxomoura@gmail.com