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Spatial distribution of avoidable cancer deaths in Germany

An Erratum to this article was published on 29 August 2012

Abstract

Aim

To investigate the spatial distribution of avoidable cancer mortality (ACM) rates in Germany and to identify small areas with exceptionally high rates using districts (Landkreise/Kreise and kreisfreie Städte) as a unit of analysis. Avoidable cancer mortality reflects deaths from cancer that should not occur in the presence of effective and timely health care.

Methods

Age-standardised, average ACM rates were calculated for the period from 2000 through 2004 for each of the 439 districts in Germany using unit-record mortality data. The spatial distribution of ACM was subsequently analysed using country maps, interval estimates and regression analysis. Data on mortality and age distribution were obtained from the German Federal Statistical Office (DESTATIS) and the Federal Office for Building and Regional Planning (INKAR).

Results

We found that in women under 70 years, the highest ACM rates were seen for cancer of the breast and for cancer of the trachea, bronchus and lung, whereas in men under 70 years, the highest ACM rates were seen for cancer of the trachea, bronchus and lung, and for cancer of the colon, rectosigmoid junction, rectum, anus and anal canal. The statistically lowest mean ACM rates could be found in the south of Germany for men and women. Although the mean ACM rates in men in former East Germany were significantly higher than elsewhere in the country, they were not substantially higher than those in the west and northwest. The mean ACM rates in women were even lower in the east than in the northwest and west.

Conclusion

The spatial distribution of ACM rates in women in Germany showed a north-south gradient rather than the east-west gradient that often appears or, for sociohistorical reasons, is even assumed in the German context. When applying measures of ACM, we suggest using districts with statistically lower ACM rates than the nationwide average as a benchmark for the maximum number of excess deaths that should be considered preventable, whether within the current German context or beyond.

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Notes

  1. 1.

    Although we aimed to include Hodgkin’s disease (for the age group 1 to 70 years) and leukemia (for the age group 1 to 44 years) as avoidable forms of cancer in accordance with the list published by Nolte and McKee (2003), mortality data on these two disease entities were incomplete and thus had to be left out of our analysis. Considering, however, that the cancer types account for a rather small proportion of overall cancer mortality in the relevant age groups (Deutsches Krebsforschungszentrum, 2011), it seems unlikely that the absence of these data has distorted our results in any substantial way.

References

  1. Albano JD, Ward E, Jemal A, Anderson R, Cokkinides VE, Murray T (2007) Cancer mortality in the United States by education level and race. J Natl Cancer I 99:1384–1394

    Article  Google Scholar 

  2. Ando M, Wakai K, Seki N, Tamakoshi A, Suzuki K, Ito Y (2003) JACC Study Group. Attributable and absolute risk of lung cancer death by smoking status: findings from the Japan Collaborative Cohort Study. Int J Cancer 105:249–254

    PubMed  Article  CAS  Google Scholar 

  3. Andreev EM, Nolte E, Shkolnikov VM, VaraviKova E, McKee M (2003) The evolving pattern of avoidable mortality in Russia. Int J Epidemiol 32:437–446

    PubMed  Article  Google Scholar 

  4. Becker N (2001) Entwicklung der Inzidenz und Mortalität an Brustkrebs. Radiologe 41:337–343

    PubMed  Article  CAS  Google Scholar 

  5. Becker N, Wahrendorf J (1998) Cancer maps of Germany 1981–1990. Springer-Publishing Company, Berlin-Heidelberg-New York

    Google Scholar 

  6. Bonneux L, de Huisman CC, Beer JA (2010) Mortality in 272 European regions, 2002–2004. An update. Eur J Epidemiol 25(2):77–85

    PubMed  Article  Google Scholar 

  7. Borrell C, Marí-Dell’olmo M, Serral G, Martínez-Beneito M, Gotsens M (2010) MEDEA Members. Inequalities in mortality in small areas of eleven Spanish cities (the multicenter MEDEA project). Health Place 16(4):703–711

    PubMed  Article  Google Scholar 

  8. Cerhan J, Potter J, Gilmore J, Janney C, Kushi L, Lazovich A (2004) Adherence to the AICR cancer prevention recommendations and subsequent morbidity and mortality in the Iowa Women’s Health Study cohort. Cancer Epidem Biomar 13:1114–1120

    Google Scholar 

  9. Charlton JR, Velez R (1986) Some international comparisons of mortality amenable to medical intervention. BMJ 292:295–301

    PubMed  Article  CAS  Google Scholar 

  10. Charlton JR, Hartley RM, Silver R, Holland WW (1983) Geographical variation in mortality from conditions amenable to medical intervention in England and Wales. Lancet 1:691–696

    PubMed  Article  CAS  Google Scholar 

  11. Chen JT, Rehkopf DH, Waterman PD, Subramanian S, Coull B, Cohen B, Ostrem M, Krieger N (2006) Mapping and measuring social disparities in premature mortality: the impact of census tract poverty within and across Boston neighborhoods, 1999–2001. J Urban Health 83(6):1063–1084

    PubMed  Article  Google Scholar 

  12. Chung JI, Song YM, Choi JS, Kim BM (2008) Trends in avoidable death over 20 years in Korea. J Korean Med Sci 23:975–981

    PubMed  Article  Google Scholar 

  13. Coleman MP, Babb P, Sloggett A, Quinn M, De Stavola B (2001) Socioeconomic inequalities in cancer survival in England and Wales. Cancer 91:208–216

    PubMed  Article  CAS  Google Scholar 

  14. DESTATIS (2007) Statistics Germany: Geburten in Deutschland. DESTATIS, Wiesbaden

    Google Scholar 

  15. Deutsches Krebsforschungszentrum (2009). Tabakatlas Deutschland. Steinkopff, Darmstadt

  16. Deutsches Krebsforschungszentrum (2011) Die 20 häufigsten Krebstodesursachen in Deutschland im Jahr 2008. http://www.dkfz.de/de/krebsatlas/gesamt/organ.html, accessed 26 May 2011

  17. Dobritz J (1997) Der demographische Wandel in Ostdeutschland—Verlauf und Erklärungsansätze. Zeitschrift für Bevölkerungswissenschaft 22:239–268

    Google Scholar 

  18. European Commission (2011) NUTS—Nomenclature of territorial units for statistics: National structures (EU). (http://epp.eurostat.ec.europa.eu/portal/page/portal/nuts_nomenclature/correspondence_tables/national_structures_eu, accessed 26 May 2011

  19. Gaber E (2011) Sterblichkeit, Todesursachen und regionale Unterschiede. Gesundheitsberichterstattung – Themenheft, April. Berlin

  20. Holland WW (1988) European Community atlas of avoidable death [1974–1978]. Oxford University Press, Oxford

  21. Humblet PC, Lagasse R, Leveque A (2000) Trends in Belgian premature avoidable deaths over a 20 year period. J Epidemiol Commun H 54:687–691

    Article  CAS  Google Scholar 

  22. IARC (International Agency for Research on Cancer) (2011) http://www.iarc.fr/, last time accessed 26 May 2011

  23. James PD, Manuel DG, Mao Y (2006) Avoidable mortality across Canada from 1975 to 1999. BMC Public Health 23:137

    Article  Google Scholar 

  24. Korda RJ, Butler JRG, Clements MS, Kunitz SJ (2007) Differential impacts of health care in Australia: trend analysis of socioeconomic inequalities in avoidable mortality. Int J Epidemiol 36:157–165

    PubMed  Article  Google Scholar 

  25. Lampert T, Burger M (2004) Rauchgewohnheiten in Deutschland – Ergebnisse des telefonischen Bundes-Gesundheitssurveys 2003. Gesundheitswesen 66:511–551

    Google Scholar 

  26. Levi F, Lucchini F, Negri E, Zatonski W, Boyle P, la Vecchia C (2004) Trends in cancer mortality in the European Union and accession countries, 1980–2000. Annuals of Oncology 15:1425–1431

    Article  CAS  Google Scholar 

  27. Mackenbach JP, Kunst AE, Looman CW, Habbema JD, van der Maas PJ (1988) Regional differences in mortality from conditions amenable to medical intervention in the Netherlands: a comparison of four time periods. J Epidemiol Commun H 42:325–332

    Article  CAS  Google Scholar 

  28. Mackenbach JP, Bouvier-Colle MH, Jougla E (1990) Avoidable mortality and health services: a review of aggregate data studies. J Epidemiol Commun H 44:106–111

    Article  CAS  Google Scholar 

  29. Mandelblatt JS, Yabroff KR, Kerner JF (1990) Equitable access to cancer services: a review of barriers to quality care. Cancer 86:2378–2390

    Article  Google Scholar 

  30. Maschewsky-Schneider U, Lampert T, Kröger C, Schulze A, Stander V, Töppich J (2006) Evaluation des Gesundheitsziels „Tabakkonsum reduzieren“. Bundesgesundheitsbl-Gesundheitsforsch-Gesundheitsschutz 49:1155–1161

    Article  CAS  Google Scholar 

  31. McNally RJQ, Pearce MS, Parker L (2006) Space-time clustering analyses of testicular cancer amongst 15–24-year-olds in Northern England. Eur J Epidemiol 21(2):139–144

    PubMed  Article  CAS  Google Scholar 

  32. Michelozzi P, Perucci CA, Forastiere F, Fusco D, Ancona C, Dell’Orco V (1999) Inequality in health: socioeconomic differentials in mortality in Rome, 1990–95. J Epidemiol Commun H 53:687–693

    Article  CAS  Google Scholar 

  33. Nolasco A, Melchor I, Pina JA, Pereyra-Zamora P, Moncho J, Tamayo N, García-Senchermes C, Zurriaga O, Martínez-Beneito MA (2009) Preventable avoidable mortality: evolution of socioeconomic inequalities in urban areas in Spain, 1996–2003. Health Place 15(3):702–711

    PubMed  Article  Google Scholar 

  34. Nolte E, McKee M (2003) Measuring the health of nations: analysis of mortality amenable to health care. BMJ 327:1129

    PubMed  Article  Google Scholar 

  35. Nolte E, McKee M (2004) Does health care save lives? Avoidable mortality revisited. The Nuffield Trust

  36. Nolte E, Wait S, McKee M (2006) Investing in health. Benchmarking health systems. The Nuffield Trust

  37. Poikolainen K, Eskola J (1986) The effect of health services on mortality: decline in death rates from amenable and non-amenable causes in Finland, 1969–81. Lancet 1:199–202

    PubMed  Article  CAS  Google Scholar 

  38. Robert Koch Institute & Association of Population-based Cancer Registries in Germany (2010) Population-based Cancer Registries: Cancer in Germany, 2005–2006. Incidence and Trends, 7th edn. Robert Koch Institute and Association of Population-based Cancer Registries in Germany, Berlin

    Google Scholar 

  39. Rosenberg MS, Sokal RR, Oden NL, DiGiovanni D (1999) Spatial autocorrelation of cancer in Western Europe. Eur J Epidemiol 15(1):15–22

    PubMed  Article  CAS  Google Scholar 

  40. Rutstein DD, Berenberg W, Chalmers TC, Child CG, Fishman AP, Perrin EB (1976) Measuring the quality of medical care. A clinical method. N Engl J Med 294:582–588

    PubMed  Article  CAS  Google Scholar 

  41. Sanchez JA, Sanchis Noguera B, Prado Del Baño MJ, Sabater Pons A, Sanchez CS (1993) Testing a new health indicator: Using avoidable causes of death and life expectancy for Spain between 1975–1986. Eur J Epidemiol 9:33–39

    Article  Google Scholar 

  42. Sarfati D, Hill S, Blakely T, Robson B, Purdie G, Dennett E (2009) The effect of comorbidity on the use of adjuvant chemotherapy and survival from colon cancer: a retrospective cohort study. BMC Cancer 9:116

    PubMed  Article  Google Scholar 

  43. Simpson HW, McArdle CS, George WD, Griffiths K, Turkes A, Pauson AW (2002) Pregnancy postponement and childlessness leads to chronic hypervascularity of the breasts and cancer risk. Brit J Cancer 87:1246–1252

    PubMed  Article  CAS  Google Scholar 

  44. Song YM, Byeon JJ (2000) Excess mortality from avoidable and non-avoidable causes in men of low socioeconomic status: a prospective study in Korea. J Epidemiol Commun H 54:166–172

    Article  CAS  Google Scholar 

  45. Sundmacher L, Kimmerle J, Latzitis N, Busse R (2011) Vermeidbare Sterbefälle in Deutschland: Räumliche Verteilung und regionale Konzentrationen. Das Gesundheitswesen 73(4):229–237

    Google Scholar 

  46. Tobias M, Jackson G (2001) Avoidable mortality in New Zealand, 1981–97. Aust N Z J Public Health 25:12–20

    PubMed  Article  CAS  Google Scholar 

  47. Treurniet HF, Boshuizen HC, Harteloh PPM (2004) Avoidable mortality in Europe (1980–1997): a comparison of trends. J Epidemiol Commun H 58:290–295

    Article  CAS  Google Scholar 

  48. Vainio H, Bianchini F (2002) Weight control and physical activity. IARC Press, Lyon

    Google Scholar 

  49. Ward J, Girgis S, Adily A (2006) Attributable fractions for premature mortality avoidable through public health action: updated estimates by Australian public health physicians. Aust N Z J Public Health 30:407–412

    PubMed  Article  Google Scholar 

  50. Weisz D, Gusmano MK, Rodwin VG, Neuberg LG (2008) Population health and the health system: a comparative analysis of avoidable mortality in three nations and their world cities. Eur J Public Health 18:166–172

    PubMed  Article  Google Scholar 

  51. Wiesner G, Bittner EK (2004) Life expectancy, potential years of life lost (PYLL), and avoidable mortality in an East/West comparison. Bundesgesundheitsblatt 47:266–278

    Article  CAS  Google Scholar 

  52. World Health Organization (2007) The World Health Organization’s Fight against Cancer: Strategies that Prevent, Cure and Care. World Health Organization, Geneva

    Google Scholar 

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The authors declare that they have no conflicts of interest.

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Correspondence to Leonie Sundmacher.

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Sundmacher, L., Gaskins, M.D., Hofmann, K. et al. Spatial distribution of avoidable cancer deaths in Germany. J Public Health 20, 279–288 (2012). https://doi.org/10.1007/s10389-011-0441-3

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Keywords

  • Avoidable cancer mortality
  • Spatial distribution
  • Germany
  • Health geography
  • Country maps