Spatio-Temporal Variation of Lung Cancer in Crete, 1992–2013. Economic or Health Crisis?

Dimitra Sifaki-Pistolla (), Vasiliki Eirini Chatzea, Enkeleint A. Mechili, Filippos Koinis, Vassilis Georgoulias, Christos Lionis and Nikos Tzanakis
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Dimitra Sifaki-Pistolla: Cancer Registry of Crete, School of Medicine, University of Crete, 700 13 Heraklion, Greece
Vasiliki Eirini Chatzea: Cancer Registry of Crete, School of Medicine, University of Crete, 700 13 Heraklion, Greece
Enkeleint A. Mechili: Cancer Registry of Crete, School of Medicine, University of Crete, 700 13 Heraklion, Greece
Filippos Koinis: Cancer Registry of Crete, School of Medicine, University of Crete, 700 13 Heraklion, Greece
Vassilis Georgoulias: Cancer Registry of Crete, School of Medicine, University of Crete, 700 13 Heraklion, Greece
Christos Lionis: Cancer Registry of Crete, School of Medicine, University of Crete, 700 13 Heraklion, Greece
Nikos Tzanakis: Cancer Registry of Crete, School of Medicine, University of Crete, 700 13 Heraklion, Greece

IJERPH, 2022, vol. 19, issue 19, 1-10

Abstract: (1) Background: This is the first population-based study in Greece, with the aim to measure the changing trends of lung cancer (LC) and the associated risk factors before and after the economic crisis. Among the main objectives were the identification of LC hot spots and high-risk areas; (2) Methods: The study was conducted in Crete, the biggest island in Greece. Data (5057 LC cases) were collected from the Cancer Registry of Crete (CRC). The age-standardized incidence and mortality rates (ASIR, ASMR/100,000/year) were estimated, while additional indexes were used, including the adjusted Charlson’s comorbidity index (CCI%), the deprivation index (HPI-2), and the exposure to outdoor air pollution (OAP). The analysis was performed for two time periods (Period A: 1992–2008; Period B: 2009–2013); (3) Results: ASIR presented a significant increase during the economic crisis, while an even higher increase was observed in ASMR (Period A: ASMR = 30.5/100,000/year; Period B: ASMR = 43.8/100,000/year; p < 0.001). After 2009, a significant increase in the observed LC hot spots was identified in several sub-regions in Crete ( p = 0.04). The risk of LC mortality increased even more for smokers (RR = 5.7; 95%CI = 5.2–6.3) and those living in highly deprived geographical regions (RR = 5.4; 95%CI = 5.1–5.8) during the austerity period. The multiple effect of LC predictors resulted in adjusted RRs ranging from 0.7 to 5.7 within the island ( p < 0.05); (4) Conclusions: The increased LC burden after the onset of the economic crisis, along with a changing pattern of LC predictors stressed the urgent need of geographically oriented interventions and cancer control programs focusing on the most deprived or vulnerable population groups.

Keywords: lung cancer; spatial epidemiology; cancer surveillance; economic crisis; deprivation; global health (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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