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Aim: This study aimed to evaluate how age, period, and cohort (A-P-C) impact colorectal cancer (CRC) incidence in Spain from 1990 to 2019., Method: Using data from the Global Burden of Disease Study 2019, we used joinpoint analysis to identify long-term trends and A-P-C modelling to quantify net drift, local drift, longitudinal age curves, and rate ratios (RRs) of period and cohort effects., Results: CRC incidence increased steadily in Spain from 1990 to 2019, with a more significant rise in males than in females. The age standardized rates rose from 84.9 to 129.3 cases per 100,000 in males and from 56.9 to 70.3 cases per 100,000 in females. Joinpoint analysis revealed distinct patterns for men and women: male incidence showed three phases (a surge until 1995, a slowdown until 2012, and a subsequent decrease) while female incidence showed a single increase until 2011 and then stabilized. Local drifts increased in all age groups over 45, with stability in males under 45 and a decrease in females aged 30-39. The risk of CRC increased with age, with males consistently having a higher risk than females. The risk of CRC increased over time for both men and women but at different rates. The risk for cohorts born in the early to mid-20th century peaked in the 1960s and remained stable until the late 1990s., Conclusion: The increasing incidence of CRC in Spain, with distinct patterns by gender and birth cohort, underlines the importance of preventive strategies adapted to temporal and demographic variations to address this public health challenge.

This study analyses the arrival-cohort effects on the newborn birthweight of Latina women residing in Spain. First, it has been tested whether women of Latin American origin in Spain have an advantage in terms of birth outcomes, a pattern previously documented in the United States and referred to as the 'Latin American paradox'. Second, it has been examined whether this health advantage of Latina mothers varies by arrival cohort.A novel database provided by the Spanish National Statistics Office that links the 2011 Census with Natural Movement of the Population records from January 2011 to December 2015 has been used. Poisson regression models were applied to test for differences in the incidence rates of low birthweight (LBW) and high birthweight (HBW) among children of Latina and native mothers, controlling for various demographic, socio-economic, and birth characteristics.Two distinct arrival-cohort effects on perinatal health were observed. On one hand, first-generation Latina women were found to be at a lower risk of giving birth to LBW infants; however, they experienced a higher incidence of HBW during the study period. Second, Latina women of 1.5 generation, likely stressed by increased exposure to the receiving country, exhibited adverse birthweight results.

Background: this study aimed to evaluate the effects of age, time period and cohort (A-P-C) on gastric cancer (GC) mortality in Spain from 1980 to 2021., Methods: an ecological trend study was performed (with aggregated data obtained from the Spanish National Statistics Institute (INE). Joinpoint regression software was used to estimate rates by sex and age group (< 35, 35-64, > 64 years) and mortality trends. The National Cancer Institute A-P-C tools were used to assess the effects of age, time of death and birth cohort., Results: GC mortality rates in Spain decreased significantly in both sexes. In the under-35 age group, rates were stable after an initial significant decline. In the 35-64 age group, the decline was more pronounced in males than in females. In the 65+ age group, rates fell significantly for both sexes, but more so for females than for males. The net drift and local drift also showed significant decreases across all age groups from 24 years onwards. GC mortality rates increased with age and decreased with calendar time and successive birth cohorts, regardless of sex. The ratio of age-specific rates between males and females increased with age, and birth cohort relative risk estimates followed a steady downward trend until the mid-1970s, after which the decline stabilized. The relative risk decreased for both sexes, with a more pronounced decrease in males., Conclusion: GC mortality rates in Spain have been decreasing over time and across successive birth cohorts, with a stabilizing trend observed for those under 35 years of age.

Background: The aim of the study is to provide up-to-date information and evaluate the age-period-cohort effects of age-period cohorts on lung cancer (LC) mortality in Spain for the period 1982 to 2021., Methods: We analysed deaths by LC and population for the period 1982-2021, available from the Spanish National Institute of Statistics. The LC corresponds to code 162 and codes C33 and C34 of the 9th and 10th editions of the International Classification of Diseases, respectively. Age-period-cohort (A-P-C) modelling was applied to compute the net drift, local drift, longitudinal age curve, and rate ratios (RR) of each period and cohort. A-P-C analysis was performed using the A-P-C Web Tool provided by the National Cancer Institute of the United States., Results: Estimated relative risk in the male birth cohorts has followed a steady downward trend in all cohorts born since 1922, showing an initial period (1922-1947) of slight decline, followed by a more marked decrease in the cohorts born during the period 1947-1977. In the younger cohorts (1977-1997), the decline appears to have stabilised. In women, a strong cohort effect is observed. In those born after the Spanish Civil War (1936 to 1939), the risk increased until it peaked in the 1960s, after which it started to decrease with the same intensity. Period RR in men decreased from 1987 to 1991 (1.1) to 2017-2021 (0.6), while period RR in women increased during this time (from 0.8 to 1.6)., Conclusions: The cohort effect observed in women born after the Civil War suggests that the onset of the LC epidemic may have been due to a higher prevalence of women smokers in these cohorts. However, the trend observed in the younger cohorts suggests a possible slowing-down in the increase in mortality risk in the following years., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

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The emergence of the AIDS epidemic in the early 1980s had a significant impact in Europe because it reawakened concerns about infectious diseases thought to be long-conquered by that time. So it not only affected mortality at certain relatively young ages, but also shifted the perception of health care needs. Even today, AIDS mortality in Spain is among the highest in Europe. It peaked there in 1994 before the wider use of combination therapy reduced the probability of dying from the disease. Analysis of data for that year reveals excess AIDS mortality among young adults. This phenomenon created a temporary but significant deformation of the risks of dying for people in their thirties: in the mid-1990s, AIDS mortality represented almost a third of total mortality in this age group in Spain. [ABSTRACT FROM AUTHOR]

Objective: To analyse the social inequalities in health between children and youth population of an immigrant origin from low-income countries and those of native origin in the Basque Country., Method: Cross-sectional descriptive study using data from the Basque Country Health Survey 2013. Variables of health, behaviours and life conditions were used as the outcome variables. Prevalence ratios were calculated using robust Poisson models., Results: The children with immigrant parents had poorer self-rated health, a higher prevalence of obesity, spent more hours in sedentary activities and lived in households with greater economic difficulties. The differences persisted even after adjusting for social class and educational level of parents., Conclusions: A migrant background is a highly relevant axis of health inequalities and has an influence beyond a generation. Given this reality, it is necessary to implement effective and suitable measures to ensure life with good health conditions and to reduce social inequalities in health, not only in childhood but through the entire life cycle., (Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Applying sexual stature dimorphism (SSD) to history and the social sciences faces the difficulty of disentangling nature from nurture in addition to the limitations of sources (e.g. small, fragmented or heterogeneous samples)., Aim: To investigate the relationship between inter-generational changes and social differences in SSD and the evolution of living conditions in 20th-century Spain., Subjects and Methods: Self-reported height and socio-demographic information from individuals born 1910-1979 (n = 99,023) were drawn from health interview surveys. Weighed least squares regression was used to construct continuous time-cohort series of SSD for the entire population and for specific socioeconomic groups represented by levels of educational attainment., Results: SSD remained below modern values among cohorts that were exposed to structural deprivation at pre-adult ages. Socioeconomic status mediated the correction of these deviations among subsequent cohorts. Lower classes (less educated segments of the population) systematically deviated to a greater extent from normal modern SSD values and they reached these values later in time., Conclusions: In Spain, variations in SSD have been found that are associated with both socioeconomic changes at a nationwide level and SES differentials at the individual level, thus continuous series of this indicator offer new opportunities in the study of living conditions of current and past generations.

Background: The aim of this article is to evaluate the age-period-cohort effects on mortality from cerebrovascular disease in Andalusia (southern Spain) as a whole and in each of its 8 provinces during the period 1981-2008., Methods: A population-based ecologic study was conducted. In all, 145,867 deaths were analyzed for individuals between the ages of 15 and 84 years who died in Andalusia in the period of study. A nonlinear regression model was estimated for each gender group and geographic area. The effects of age, year of death, and birth cohort were parameterized using spline smoothing functions., Results: There is an upward trend in mortality from the age of 25 years. The risk of death was downward for cohorts born after 1896, decreasing after 1970 with steep slope. The analysis of the period effect showed that death rate first declined from 1981 to 1995 and then increased between 1995 and 2000, only to decrease again until 2008., Conclusions: There is a similar age-period-cohort effect on male and female mortality from cerebrovascular disease in all the provinces of Andalusia and for Andalusia as a whole. A significant reduction of male and female mortality has been observed during the last decade., (Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.)

Objective: To study the trend pattern of the incidence of thyroid cancer., Methods: We selected incident cases of thyroid cancer occurring in the Region of Murcia (Spain) in 1984-2008. The variables gathered were age, sex, date of diagnosis, and morphology. We calculated incidence rates and the annual percentage of change using Bayesian age-period-cohort models., Results: During the study period, 1414 cases were diagnosed, representing an increase in adjusted rates from 2.9/100000 in 1984-1988 to 7.3 in 2004-2008. The incidence was 3.5 times higher in women than in men and the most frequent morphology was papillary carcinoma (67.7%). An increasing trend was found in both genders; these increments were more pronounced in papillary carcinoma. In women, the incidence increased with age, calendar year, and in those born in 1945-1963. The incidence of papillary microcarcinoma increased four-fold in women., Conclusions: Thyroid cancer used to be a rare cancer but has become an emerging tumor. The greatest changes were found in papillary thyroid cancer, including a gradual increase in the proportion of microcarcinoma., (Copyright © 2014 SESPAS. Published by Elsevier Espana. All rights reserved.)

Background: Men present higher overall rates of substance use and abuse than women; yet, evidence suggests that an increase of substance use by the younger cohorts of women in recent decades is narrowing this gap in western societies. Moreover, younger cohorts may also be reporting earlier initiation of substance use, representing an increased risk for developing substance-related problems. With this study we intend to identify changes in the patterns of substance use of men and women in Spain for public health policy, planning and intervention., Methods: Sex differences in the cumulative incidence of alcohol, tobacco, cannabis and cocaine were examined by birth cohort using a combined sample of individuals aged 15-64 years from eight editions of the Spanish National Survey on Drugs (1995-2009)., Results: Initiation of substance use in Spain is progressively taking place at younger ages, particularly among women. The gender-gap of life-time occurrence of substance use is narrowing (cannabis and cocaine) almost closing (alcohol) and even reversing (tobacco) in the youngest cohort., Conclusion: These results reflect the particular evolution and trends of Spanish society regarding substance use. Women's increased use of substances and the earlier age of initiation of substance use by both sexes present particular challenges for prevention and treatment of future substance-related problems. The trends registered for legal and illegal substances would require re-evaluation of existing prevention policies., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Breast cancer is the most common cancer in women worldwide. The analysis of breast cancer mortality is needed to plan healthcare systems. This study aims to evaluate the age-period-cohort effects on breast cancer mortality in Andalusia (Southern Spain) as a whole and in each of its eight provinces during the period 1981-2008. A population-based ecological study was conducted. In all, 19,707 deaths from breast cancer were analysed for individuals between the ages of 40 and 84 years who died in Andalusia in the period of study. A nonlinear regression model was estimated for each gender group and geographical area. The effects of age, year of death and birth cohort were parameterised using B-spline smoothing functions. There is an upward trend in mortality by age until around the age of 75 years, from which point the trend turned downwards. The analysis of the cohort effect reveals a steady fall in breast cancer mortality risk for female generations born after 1940. Death rates increased until 1995 and then declined until the end of the period. There is an age-period-cohort effect on breast cancer mortality similar in all the provinces of Andalusia and for Andalusia as a whole. If the current trends continue, it can be expected that these effects will continue to reduce female mortality.

Background: While the timing of reproductive events varies across populations, a downward trend in age at menarche has nevertheless been reported in most of the developed world over the past century. Given the impact of change in age at menarche on health conditions, this study sought to examine secular trends in age at menarche among women living in Navarre (Northern Spain) who participated in a population-based breast cancer screening programme., Methods: The study was based on 110545 women born from 1925 to 1962. Trends were tested using a linear regression model, in which year of birth was entered continuously as the predictor and age at menarche (years) as the response variable, using size of town and region of birth as covariates., Results: Among women born in Navarre between 1925 and 1962, age at menarche declined steadily from an average of 13.72 years in the 1925-1929 birth-cohorts to 12.83 years in the 1958-1962 birth-cohorts. Controlling for size of town or city of birth, age at menarche declined by an average of 0.132 years every 5 years over the period 1925-1962. This decline was greater in women born in rural versus urban settings. Trends were also different among regions of birth., Conclusion: We report a population-based study showing a downward trend in age of onset of menarche among Spanish women born in the period 1925-1962, something that is more pronounced among women born in rural settings and varies geographically.

We examine the influence of socio-environmental (and birth cohort specific) effects on both adult height and gender dimorphism (height gap). Our data set is from contemporary Spain, a country governed by an authoritarian regime for about 40 years. Both OLS and quantile regression approaches are used to examine these patterns. Furthermore, we then draw upon a Blinder-Oaxaca decomposition approach to explain the influence of socio-political environment in explaining gender dimorphism. Our findings point to a significant increase in adult height in the generations that benefited from the country's economic liberalization in the 1950s, and especially among those brought up after the transition to democracy in the 1970s. In contrast, individual heterogeneity suggests that only in recent generations has "height increased more among the tallest". We also find that the effects of education on height are greater among shorter individuals. Although the mean gender difference in height is 11.7cm, birth cohort and capabilities effects along with other controls explain on average roughly 4% of the gender height dimorphism, irrespective of the quantile considered.

Recent statistics cohort analysis of mortality reveals that skin melanoma rates are dropping in the younger cohorts. Therefore, the aim of this study is to provide up-to-date information and to analyze recent changes in skin melanoma mortality trends in Spain during the period of 1975-2004 using joinpoint regression and age-period-cohort models. Between 1975 and 2004, the age-standardized (overall) mortality rates for skin melanoma increased from 0.3 to 1.3 per 100,000 person-years for males and from 0.2 to 0.8 per 100,000 person-years for females, with an estimated annual percentage of change of 4.8 and 4.3%, respectively. In men and women, the best fit was found for the full model, which simultaneously considered the effects of age, period and cohort. The risks among both males and females increased in each successive birth cohort born between 1895 and 1950. Thereafter, the risks declined through the most recent birth cohort born in 1970. Examination of the mortality trends by age group and birth cohort revealed that the recent less rapidly rising (men) or stabilizing (women) age-adjusted skin melanoma mortality rates in Spain were a result of declining mortality in the younger age groups and more recent birth cohorts. The particularly favorable trends in young people suggest that a further decline in mortality from skin melanoma in Spain is likely to occur within the next few years., ((c) 2007 Wiley-Liss, Inc.)

The aim of this study was to analyze stroke mortality rates in Andalusia during the period from 1975 to 1999 by studying age, cohort and period effects. Deaths due to stroke along with the corresponding population figures were divided into 11 age groups and five 5-year periods. From this, age-specific mortality rates for 15 birth cohorts were then computed. These were plotted and fitted to Poisson regression models to assess age, period and cohort effects. An exponential age effect was present for both sexes regardless of cohort or period. The rates of stroke mortality decreased significantly among both sexes in Andalusia during the study period, although in recent years, this declining trend has started to slow down, primarily in males. Age- and period-adjusted stroke mortality was greater for earlier cohorts and lower for generations born at the beginning of the 20th century., (Copyright 2002 S. Karger AG, Basel)

Background: An increase in the mortality due to motor neuron disease (MND) has been reported in Spain over the past 30-40 years. It has been suggested that this increase is due to the cohort effect, but his hypothesis has not been proven., Methods: The motor neuron disease (MND) mortality statistics by age and by gender were furnished from the Spanish National Institute of Statistics. The mortality specifically by age and the adjusted age-related rates were calculated. By Poisson regression, the cohort effect of birth on the mortality by ages has been analyzed, the cohort effect also having been analyzed by graphic methods., Results: The mortality adjusted by age was declining up until 1969, as of which time it has been on the rise. Each five-year birth cohort increases the risk of dying from MND by 8.5%., Conclusions: The increase in the mortality due to MND in Spain is the result of a cohort effect.

Study Objective: This study describes mortality due to cerebrovascular disease (CVD) in Spain, based on time-series analysis in the period 1951-1995 by age, sex, and cohort of birth; spatial distribution observed for the five-year period 1991 1995, and time-spatial analysis in the period 1992-1995 vs. 1988-1991. Special attention is paid to risk of medium aged population., Design: Longitudinal and cross-sectional observational study., Setting and Participants: Spanish population. All mortality data used were taken from official statistics. Time trends and spatial distribution were analyzed using log-linear Poisson regression models., Main Results: CVD mortality declined over the last two decades of the study period (1974-1995) by an annual average of 4.16% (95% CI: 3.95-4.36) and 4.00% (95% CI: 3.77-4.24) in men and women, respectively. The downward trends were accelerated in last decade. An excess of male mortality was in evidence. For all age groups mortality declined with more recent cohorts, but the decline was less marked among ages 35 64. Spatial distribution of CVD mortality revealed a north-south pattern, but this is being difuminated by increasing rates in the lower risk provinces. Internationally, Spain ranks midway to low in terms of its overall CVD mortality., Conclusions: Efforts to reduce CVD incidence and case fatality are the essential prerequisite for any long-term improvement in mortality. Accordingly, further research is called for into current disease morbidity and the risk factors to be targeted at a general population level, nationwide.

Several studies have detected increases in malignant brain tumour incidence and mortality rates particularly among the elderly. We analyzed time trends in malignant brain tumors incidence in Zaragoza over the period 1973-1990 and Navarre over the period 1973-1991, two Spanish provinces that have been collecting data through their respective Cancer Registries for the last 20 years, using Poisson regression analysis of age, period of diagnosis and cohort. In general, age-adjusted rates showed a steady rise in both registries, except in the case of females in Navarre, for whom a decrease in risk was observed for the last period, 1988-1991. This increase is a reflection of the rise in incidence experienced by the elderly, since the cohorts successively register rates that are stable over time, and even downward in the case of females in Navarre. The risk run by generations born circa 1920-1930 was the highest encountered. Rates were higher in Navarre in both sexes and for all but the last period in females, when rates on the two registers stood level. Increasingly generalised use of CT scanning and magnetic resonance in the 1980s in Spain, coupled with better and more effective health care access for the elderly, are factors that may well have some bearing on these findings.

In this paper we look at the behaviour of households as far as participation and rate of consumption of tobacco are concerned using cohort data from the Spanish Continuous Family Expenditure Survey during the period 1985-94. We test the results, in statistical and economic terms, from several estimators on samples with different levels of aggregation and offer evidence on the different behaviour of households according to several demographic characteristics. The results suggest that the effect of legislative measures cannot be identified when participation and consumption are not separately considered. Once we do so, these measures seem to affect participation alone.

Spain registers a much lower rate of colorectal cancer incidence and mortality than do other European countries, yet the rises observed in the adjusted rates over recent decades led us to attempt to monitor the trends over time using Poisson log-linear models. Incidence data were furnished by the Zaragoza and Navarre population-based cancer registries, whereas mortality data corresponded to Spain as a whole. For trend evaluation purposes, we made use of invariant parameters from age-period-cohort models (net drift and curvature) and a restriction of the cohort-effect slope range. The results suggest the presence of a marked rise in incidence of colorectal cancer for both sexes and across all age groups in the provinces studied. The rise in mortality was less pronounced than the rise in incidence and seemed to coincide with a marked cohort effect present throughout the study period. Both in incidence and mortality, the increases were more pronounced among men. When studied jointly, incidence and mortality trends tend to be complementary, rendering an approach of this nature especially important in sites with better survival, such as the case in point.

Study Objective: To describe time trends in gastric cancer incidence in Zaragoza and Navarre, and to investigate time period and birth cohort as determinants of such trends., Design: Cases from two registries were grouped into five year intervals and the following were calculated: age specific and sex specific incidence rates, and the male to female ratio. Log linear models including age, period of diagnosis, and birth cohort were fitted., Setting: The Zaragoza Cancer Registry covers the province of Zaragoza, which has a population of 824,776 (403,755 men and 421,021 women). The Navarre Cancer Registry covers the province of Navarre which has 512,512 inhabitants (254,786 men and 257,726 women). In both cases population figures were based on the late census., Patients: These comprised incident cases of gastric cancer reported to the Zaragoza Cancer Registry in 1963-87 and to the Navarre Cancer Registry in 1973-87., Main Results: Navarre registered higher adjusted and cumulative rates than Zaragoza for both sexes. In both provinces, there were relative declines in the rates for men and women of 3% and 4% respectively per year. In Zaragoza, the risk of developing stomach cancer fell in generations born between 1888 and 1933, and rose in subsequent birth cohorts in both sexes, while in Navarre the cohort effect showed an approximately linear risk for both sexes. Both provinces recorded increases in risk associated with cohorts born between 1933 and 1943., Conclusion: The incidence rates of gastric cancer fell in both Zaragoza and Navarre. The reason for the greater incidence of gastric cancer in Navarre remains unknown. Trends in rates seem to be mainly linked to birth cohort. Increases in risk in generations born after 1933 may be ascribable to nutritional deficiencies in the early years of life.

Using log-linear Poisson modelling, trends in childhood cancer mortality among the population under 20 years of age in Spain are described over the 35-year period from 1956 to 1990. Overall cancer mortality and seven specific sites were considered: all leukaemias, Hodgkin's disease, non-Hodgkin's lymphomas, malignant brain tumours, kidney cancer, malignant bone neoplasms, and a broad category of ill-defined tumours. An age-period-cohort model was used to analyse the influence of age, period of death and birth cohort. Recent trends were estimated by restricting analysis to the last three 5-year periods. In general, mortality began to decline at the beginning of the 1970s, with reductions of 36% in males and 45% in females being registered between 1966-1970 and 1986-1990. The use of age-period-cohort models revealed an initially rising period effect attributable to diagnostic advances. The decline in mortality in post-1965 generations and the final downturn in the period effect are both most certainly a consequence of the remarkable progress achieved in the treatment of such tumours. During the final 15 years, there was a relative decline in mortality of approximately 20% every 5 years. However, in the case of malignant renal tumours in males and malignant bone tumours and non-Hodgkin's lymphomas in both sexes the situation remained stable.

Hepatitis A is an infection transmitted by the fecal-oral route. Endemicity within a specific country is directly related to sanitation and hygienic standards, while being inversely related to socioeconomic conditions. We studied how the process of urbanization witnessed in Madrid had influenced the transmission of hepatitis A infection. In the Madrid Autonomous Region, this process first began in the early sixties and was not brought to a close until the late seventies. Catalytic models were used to estimate the annual infection rate, lambda, on the basis of seroprevalence data stratified by age. A cohort effect related to a fall-off in infancy-related hepatitis A virus (HAV) is to be observed in the results for the last few years. The model permits four birth cohort-based groups to be differentiated by lambda: individuals born pre-1960, lambda = 0.082 (95% CI 0.095-0.070); those born in the early sixties, lambda = 0.052 (95% CI 0.060-0.042); whose members were born in the late sixties, lambda = 0.033 (95% CI 0.041-0.025); and those born in the late seventies, lambda = 0.017 (95% CI 0.020-0.013). The first group includes those born before the urbanization process had started. The second and third groups coincide with the development stage of that process, hence exhibiting transitional rates. The fourth group reflects the process in its consolidation stage. This reduction in the transmission of infection has changed the manner of presentation, so that while isolated cases or small outbreaks tend to be more common nowadays, occasionally epidemics may evolve explosively. The average age at presentation has risen and the likelihood of symptomatic infection is higher.

Liver cancer is one of the main causes of death in Mediterranean countries. The pattern of mortality from liver cancer has been characterized by both geographical and temporal variations. In order to clarify its trend and in an attempt to hypothesize the future pattern of mortality, we analyzed data from the Spanish population, aged more than 35 yr, who died of liver cancer during the period of 1975 to 1989. The mortality data were obtained from the National Statistical Institute of Spain. We used a log-linear Poisson model to examine the effects of age, birth cohort, and calendar period of death. Age is the strongest factor in predicting liver cancer mortality according to the models. The sharp decrease in liver cancer mortality rates that had occurred in both sexes can be attributed to the joint effect of better diagnosis and assignment of metastatic tumors to the site of their primary origin, as well as to the modification of the International Classification of Diseases (ICD) code.