Research Article
Austin J Public Health Epidemiol. 2014;1(3): 1011.
Malignant Neoplasms of Urinary Tract (C64-C68) in the Osijek-Baranja County (Croatia) in the Period 2001-2009
Josip Milas1*, Senka Samardžic1 and Krunoslav Milas2
1Faculty of Medicine, Josip Juraj Strossmayer University Osijek, Croatia
2Ministry of Health, Croatia
*Corresponding author: Josip Milas, Faculty of Medicine, Josip Juraj Strossmayer University Osijek, Josipa Huttlera 4, 31000 Osijek, Croatia
Received: August 20, 2014; Accepted: September 15, 2014; Published: September 16, 2014
Abstract
Purpose: We investigated the trends of the malignant neoplasms of the urinary tract in the Osijek-Baranya County (Croatia) during the 2001-2009 period.
Methods: Mandatory county hospitals data reports, County bureaus of statistics and the County Register of Deaths of 872 cohort patients (260 females and 612 males) were used in this analysis.
Results: For the both genders, the overall age-adjusted incidence rate was 24.5/100,000 with a weak upward chronological tendency (R2=0.059); also, the overall age-standardized mortality rate of 12.2/100,000 experienced a moderate upward trend line (R2=0.350). The age-adjusted 5-year relative survival rate of all patients totalled 51.0% in 2001-2005 period. The survival rate in males (51.1%) resembled the overall survival rate and it was slightly higher than in females (50.6%). An average patient was admitted to hospital 2.7 times during the course of their illness with the average length of stay in hospital of 11.3 days. The number of hospitalizations in years 2001 to 2009 progressively grew, both from the viewpoint of the entire population of patients and seeing genders separately (R2=0.777).
Conclusion: Although the data on the incidence and mortality rate from this cancer group do not deviate much from the corresponding data on the European and Croatian level, the survival rate is far below the EU average and thus directly suggests that the health care of these cancer patients in the OBC should be substantially improved and put on a much higher level.
Keywords: Neoplasms of urinary tract; Mortality rate; Incidence rate; 5-year relative survival rate; Length of stay in hospital; Croatia
Abbreviations
ICD-10: International Statistical Classification of Diseases and Related Health Problems, 10th Revision; C64-C68: Malignant Neoplasms of the Urinary Tract; C64: Malignant Neoplasm of Kidney, Except Renal Pelvis; C65: Malignant Neoplasm of Renal Pelvis; C66: Malignant Neoplasm of Ureter; C67: Malignant Neoplasm of Bladder; C68: Malignant Neoplasm of Other and Unspecified Urinary Organs; OBC: Osijek-Baranja County; ONKO: Mandatory Statistical Reports on Every Hospitalized Cancer Patients in Croatia; BSL: Mandatory Statistical Report on Every Hospitalized Person, Regardless of the Causes of Hospitalization; CI: Confidence Interval; EU: European Union; MADG: Median Age at Diagnosis; MAD: Median Age at Death; R: Relationship; LOSH: Length of Stay in Hospital; NOAH: Number of Hospital Admissions; IPHO: The Institute of Public Health of the Osijek-Baranja County; USA: United States of America; UW: upward trendline; COD(S): coefficient of determination (strength); N: number of cases; ASR: age-standardized rate (EU); N/A: not available; BG: Both genders; F: Females; M: Males; AA: average admission in hospital per patient
Introduction
Malignant neoplasms of the urinary tract (according to the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10), group codes C64-C68) belongs to the sixth most common cancers in the OBC [1]. Comparing to the incidence rate of this cancer group in the OBC, higher rates are found in Europe and North America and lower ones are determined in Asia and South America [2]. Exposure to chemicals, cigarette smoke and family history may increase the risk of this cancer group, particular of bladder cancer (C67) [3]. The C64-C68 cancer group accounts for around 8.5% of all cancers in the USA [4]. These cancers affect more often males than females, with a males to females ratio of about 2:1 (11.3% in males and 5.6% in females) [4]. Regarding the USA population, the trends in the incidence of kidney cancer (C64) revealed a statistically significant increase among members of both genders during the 2003-2007 period whereas the trends in the occurrence of urinary bladder cancer demonstrated neither a statistically significant increase nor decrease in males, but it came to a major decrease in females. The trends in the corresponding death rates during the same period revealed a decrease in mortality from kidney cancer in both genders and in the mortality from bladder cancer within the female population. Having regard to the same population, the 5-year relative survival rate from bladder cancer amounted to 72% in males and 67% in females while the 5-year relative survival rate from kidney cancer was 56% in males and 58% in females [5]. Concerning the same cancers, the estimated incidence and mortality rate in the EU were 6.9% and 5.9%, respectively. In males, the incidence and mortality rate ware 10.5% and 7.4%, respectively. What is curious is that in females, either of the parameters did not even reach 1% [6]. Taking account of the whole corpus of patients, the 5-year relative survival rate from kidney cancer in Europe was 57% and if seeing genders separately, this rate was 57% in females and 54% in males. Patients from France, Italy, Austria and Germany are above the European average in terms of the survival from this cancer while patients from eastern European countries, England, Wales, Scotland and Denmark were not even close to the European average in this context. The European 5-year relative survival rate from bladder cancer was 71%. This rate was 70% in males and 67% in females. Bladder cancer is one of the very few cancers from which survival is better in males than in females, although the incidence rate of bladder cancer was higher among males than among females. This is a consequence of the fact females pay less attention to hematuria and other discharges than males do. Survival from both cancers (kidney and bladder) decreases with the age [7]. The median age at diagnosis of bladder cancer within the USA population was 72.9 years (74.1 years for females and 72.5 years for males) [8]. In Denmark, patients were diagnosed with kidney cancer at the average age of 68 years in the 1998-2009 period [9]. In Europe, the median age at diagnosis of kidney cancer was generally around 60 years and the male to female ratio was 3:1 [10]. In Croatia, the kidney cancer incidence rates in males and females were 4% and 3%, respectively, while the bladder cancer incidence rates were 6% and 2%, respectively [11]. In the 1994-1998 period, the 5-year relative survival rate from urinary bladder and kidney cancer in Croatia was 75% and 56%, respectively, in males and 76% and 65%, respectively, in females.
This paper focuses on the demographic (gender, age, median age) and statistical features of C64-C68 cancer patients (incidence and mortality rate, survival rate, length of stay in hospital) and is aimed at obtaining information on the status of this group of cancer in the OBC in relation to the corresponding status in Croatia and Europe in period 2001-2009.
Materials and Methods
Data source
Although the representativeness of their data might be challenged, mandatory county hospitals data reports, county bureaus of statistics and the County Register of Deaths still represent the only available source of information on the profile of cancer in the OBC. All data from the 2001-2009 periods originate from these institutions. The cohort studied in this article included all people with cancer who were registered as the patients in one of two hospitals in the OBC in the time period from 2001 to 2009 (follow up period from 1996 to 2010). Based on these sources, a database of people who were hospitalized in the area of the OBC for any reason whatsoever (including cancer) has been generated [12,13]. The data on each of the hospitalized patients have been supplemented with data obtained from the Register of Deaths.
Data on every person with cancer are accompanied with their chronological order of illness and hospitalization. The database involved all hospitalizations and all data on ONKO or BSL forms (mandatory statistical patterns for all hospitalized patients in Croatia). The ONKO form is a mandatory statistical report on every hospitalized cancer patients in Croatia. The BSL form is a mandatory statistical report on every hospitalized person, regardless of the causes of hospitalization. All cancer patients coming from this area are hospitalized in state-owned (public) hospitals since there are still the only hospitals here.
Statistical analysis
The cancers were classified according to the International Statistical Classification of Diseases and Related Health Problems (ICD-10), codes C64-C68. The cancer incidence and mortality estimates in the period from 2001 to 2009 were prepared for all cancers based on gender and for age groups 0-19, 20-44, 45-64, 65+ by the year at cancer diagnosis. Based on the 2001 census, the analysis covered a total population of 330.506 people in the OBC. The Croatian National Health Insurance is a universal health insurance that covers all or almost all costs (depending on a personal choice of the type of insurance) of treatment of Croatia citizens and provides them with of four age groups. The analyses were conducted using age-specific rates, the age-standardization-direct method and 95% confidence intervals (95% CI). The standardized incidence and mortality ratios as well as the 95% confidence intervals were computed for C64-C68 pursuant to the year at cancer diagnosis. Also, both ratios were stratified according to the year at cancer diagnosis, age and gender. The median age is the observation ranked in the middle; that is 50% of patients are diagnosed at an older age and 50% are diagnosed at a younger age compared to the median. The EU standard population was used in the analysis [14]. The length of stay was determined according to the date of admission and to the date of discharge with regard to the index admission. The SAS statistical package (version 9.1, SAS Institute INC, Cary, NC, USA) was used for the statistical analysis [15] and Microsoft® Office Excel® 2007.
Results
According to the census in 2001, the analysis covered a total population of 330.506 people in the OBC. From 2001 to 2009, a total of 872 people (260 females and 612 males) were registered with malignant neoplasms of the urinary tract (C64-C68) and treated at the two hospitals in the OBC. Malignant neoplasms of the urinary tract can be said to be cancers typical for males (70.2%) due to their appearance two times more frequent among males than among females (29.8%, Table 2). Out of all cancers in the OBC, C64-C68 cancers accounted for 6.2% of all registered cancer patients. This percentage was 3.7% in females and 8.6% in males.
Table 1A. Median age (in years) at diagnosis - females
ICD-10
2001
2002
2003
2004
2005
2006
2007
2008
2009
2001-2009
COD(S)
Strength
Trendline
C64
66.0
57.5
67.3
63.4
68.9
64.7
64.2
61.6
61.4
64.2
y=64.22x-0.00 R²=0.003
barely
DW
C65
69.3
68.1
-
31.2
-
78.4
-
72.1
71.7
65.7
y=60.26x0.026 R²=0.004
barely
UW
C66
-
-
-
76.9
-
-
64.4
-
68.6
68.6
y=95.73x-0.17 R²=0.626
strong
DW
C67
71.0
69.5
67.5
68.2
67.9
69.3
69.9
70.7
74.9
69.8
y=68.72x0.011 R²=0.066
weak
UW
C68
-
75.2
-
-
-
-
-
-
-
75.2
-
N/A
-
C64-C68
69.5
65.9
67.4
65.3
68.5
67.1
66.5
66.2
68.8
67.1
y=67.83x-0.00 R²=0.046
weak
DW
Median age (in years) at diagnosis - males
C64
58.4
61.4
63.1
61.0
62.6
65.5
65.4
59.6
64.5
62.5
y=59.35x0.034 R²=0.37
moderate
UW
C65
-
63.5
-
-
61.0
46.4
-
-
61.8
59.5
y=64.68x-0.07 R²=0.097
weak
DW
C66
-
73.8
-
-
69.3
58.2
54.6
71.8
69.9
67.0
y=75.16x-0.07 R²=0.113
weak
DW
C67
66.9
66.7
64.7
66.2
68.5
67.1
64.6
68.7
65.7
66.4
y=66.41x0.001 R²=0.002
barely
UW
C68
-
-
-
-
-
-
74.9
-
-
74.9
-
N/A
-
C64-C68
64.7
65.2
64.3
64.1
66.1
66.3
64.8
65.5
65.4
65.2
y=64.57x0.006 R²=0.154
weak
UW
Median age (in years) at diagnosis - both genders
C64
60.7
60.2
65.2
61.8
65.0
65.2
64.8
60.3
63.4
63.1
y=61.07x0.020 R²=0.182
moderate
UW
C65
69.3
65.0
-
31.2
61.0
62.4
-
72.1
66.7
62.9
y=59.78x-0.00 R²=0.000
barely
DW
C66
-
73.8
-
76.9
69.3
58.2
61.2
71.8
69.2
67.6
y=78.64x-0.08 R²=0.182
moderate
DW
C67
67.9
67.4
65.3
66.8
68.4
67.5
65.7
69.2
67.7
67.2
y=67.07x0.002 R²=0.009
barely
UW
C68
-
75.2
-
-
-
-
74.9
-
-
75.1
-
N/A
-
C64-C68
66.1
65.4
65.3
64.5
66.8
66.5
65.3
65.7
66.3
65.8
y=65.53x0.002 R²=0.026
barely
UW
COD(S) - Coefficient of determination (strength)
"-" - to small number of cases
DW - downward trendline
UW - upward trendline
N/A - not available
R - relationship
Table 1A: The median age of malignant neoplasms of urinary tract (C64-C68) at diagnosis and at death in the period from 2001 to 2009.
Table 1B. Median age (in years) at death - females
ICD-10
2001
2002
2003
2004
2005
2006
2007
2008
2009
2001-2009
COD(S)
Strength
Trendline
C64
62.5
65.0
69.2
71.8
73.8
73.4
73.9
65.8
72.2
69.3
y=63.69x0.062 R²=0.506
strong
UW
C65
69.1
68.1
-
52.1
-
-
-
76.9
-
67.5
y=65.39x0.007 R²=0.001
barely
UW
C66
-
-
-
-
-
-
79.9
-
69.3
74.6
-
N/A
-
C67
71.1
75.7
69.8
78.2
74.2
74.9
77.5
81.7
79.0
75.8
y=70.62x0.048 R²=0.485
strong
UW
C68
-
-
-
-
-
-
-
96.1
-
96.1
-
N/A
-
C64-C68
67.6
70.6
69.5
70.8
74.2
74.2
76.3
72.8
75.6
72.6
y=67.34x0.050 R²=0.784
strong
UW
Median age (in years) at death - males
C64
58.0
63.5
67.5
65.6
66.4
67.1
73.2
67.2
62.9
65.7
y=60.38x0.058 R²=0.438
moderate
UW
C65
-
59.5
-
-
50.4
-
-
75.3
68.0
64.3
y=19.35x0.607 R²=0.821
very strong
UW
C66
-
73.8
-
70.5
-
79.6
-
72.3
55.9
70.4
y=81.80x-0.09 R²=0.193
moderate
DW
C67
70.2
69.2
70.9
73.6
72.8
72.9
75.4
75.1
75.4
73.0
y=68.79x0.039 R²=0.789
strong
UW
C68
-
-
-
-
-
-
75.0
-
-
75.0
-
N/A
-
C64-C68
66.0
67.2
69.8
71.4
70.0
71.3
74.8
72.6
70.2
70.5
y=66.64x0.047 R²=0.503
strong
UW
Median age (in years) at death - both genders
C64
59.4
64.1
68.2
68.4
67.4
69.3
73.4
66.4
65.5
67.0
y=61.59x0.057 R²=0.492
strong
UW
C65
69.1
63.8
-
52.1
50.4
-
-
76.5
68.0
66.1
y=62.45x0.002 R²=0.000
barely
UW
C66
-
73.8
-
70.5
-
79.6
79.9
72.3
62.6
71.6
y=76.85x-0.03 R²=0.038
weak
DW
C67
70.4
71.1
70.6
74.2
73.2
73.3
76.1
76.5
76.3
73.7
y=69.31x0.041 R²=0.782
strong
UW
C68
-
-
-
-
-
-
75.0
96.1
-
85.5
-
N/A
-
C64-C68
66.5
68.3
69.7
71.3
71.0
72.0
75.3
72.7
71.6
71.2
y=66.49x0.044 R²=0.799
strong
UW
COD(S) - Coefficient of determination (strength)
"-" - to small number of cases
DW - downward trendline
UW - upward trendline
N/A - not available
R - relationship
Table 1B: The median age of malignant neoplasms of urinary tract (C64-C68) at diagnosis and at death in the period from 2001 to 2009.
Incidence
Mortality
C64-C68
Males
Females
Both genders
Males
Females
Both genders
Year of data collection
N
ASR
N
ASR
N
ASR
N
ASR
N
ASR
N
ASR
2001
55
34.0
22
8.4
77
19.3
32
19.8
13
5.5
45
11.5
2002
79
48.8
32
14.1
111
28.2
28
17.3
14
5.1
42
10.2
2003
69
42.6
32
13.6
101
25.5
28
17.3
12
4.7
40
9.6
2004
63
38.9
31
14.0
94
24.1
38
23.4
14
5.6
52
12.4
2005
67
41.4
27
11.6
94
23.5
50
30.8
15
5.5
65
15.3
2006
85
52.5
32
13.5
117
29.4
42
25.9
14
5.4
56
13.3
2007
69
42.6
32
13.4
101
25.5
37
22.7
19
6.9
56
12.7
2008
58
35.9
26
11.5
84
21.6
39
24.0
25
10.2
64
15.3
2009
67
41.4
26
10.8
93
23.3
38
23.4
13
5.0
51
12.2
COD(S)
R²=0.041
R²=0.110
R²=0.059
R²=0.360
R²=0.160
R²=0.350
Trendline
UW
UW
UW
UW
UW
UW
2001-2009
68.0
42.0
28.9
12.3
96.9
24.5
36.9
22.7
15.4
6.0
52.3
12.5
ASIR - age-standardized incidence rate
ASMR - age-standardized mortality rate
COD(S) - Coefficient of determination (strength)
DW - downward trendline
UW - upward trendline
N - number of cases
R - relationship
Table 2: Historical data on the malignant neoplasms of urinary tract (C64-C68), ASIR and ASMR per 100,000 (using the EU-standard population), covering the period from 2001 to 2009.
In the 2001-2009 period, the overall median age at diagnosis (MADg) of C64-C68 cancers was 65.7 years, in males 65.2 years and in females 67.1 years (Table 1A). Females were later diagnosed with this group of cancer then males by 1.9 years. The median age of males was characterized by a time shift at diagnosis to a older age for C64 (malignant neoplasm of kidney, except renal pelvis, a moderate upward trend line, R2=0.37) as a result of the same changes in all age group for C64 (Figure 1A). The median age of females had a weak opposite (downward) trend (Table 1A) mostly due to the moderate downward trend line for C64 in the age group 45-64 years (R2=0.182, Figure 1B).
Figure 1: The median by age groups of cancer patients at diagnosis (MADg) by primary cancer site C64-C68 (selected sites) in the OBC, period 2001-2009. The rising trendline suggests that a strong relationship exists in males for C64-C68 (malignant neoplasms of urinary tract) of age 45-64 years and for C64 (malignant neoplasm of kidney, except renal pelvis) between the MADg and years, R2=0.502 and R2=0.492, respectively (Figure 1A) (R2>0.48<0.81). In females moderate downwards trendline exist for cancer site C64 of age 45-64 years (R2=0.182, Figure 1B).
The overall median age at death (MAD) was 71.2 years (Table 1B). It exceeded the median age at diagnosis of C64-C68 cancers by 5.4 years. In both genders seeing as a whole as well as in each gender separately suggest that strong upward trend lines exists between MAD and years (Table 1B, Figure 2). In males, the MAD by cancers ranged from 64.3 years for patients with malignant neoplasm of renal pelvis (C65) to 73.0 years for malignant neoplasm of bladder (C67). In females, the MAD by cancers ranged from 67.5 to 75.8 years for the same cancer sites, respectively.
Figure 2: The median by age groups of cancer patients at death (MAD) by primary cancer site C64-C68 (selected sites) in the OBC, period 2001-2009. The rising trendlines suggest that strong relationships exists for C64 of age 65+ years and for whole cancer group C64-C68 of age 65+ years (2=0.544 and 2=0.655, respectively, Figure 2B).
The mean incidence of new C64-C68 malignant neoplasms over the 9-year study period was 96.9 (28.9 females and 68 males) cases/year, equating to an OBC population age-adjusted incidence rate of 24.5/100,000 (SD±2.52, CI 19.55-29.43) with a weak upward chronological tendency for both genders (R2=0.059). The overall age-standardized incidence rate in males (ASIR) (42.0/100 000) was three times higher than in females (12.3/100,000) (Table 2). The ASIR of the malignant neoplasm of kidney, except renal pelvis (C64, overall ASIR was 6.0/100,000) increased strongly in females and males (R2=0.548 and R2=0.586, respectively), particularly in the years 2004-2006 (Table 3). These data have directly impact to the whole cancer group. In males, the ASIR moderate increased in age group 20-44 (Table 5, R2=0.184), while in females in age group 45-64 and 65+ (R2=0.231).
Females
ICD-10
2001
2002
2003
2004
2005
2006
2007
2008
2009
2001-2009
Coefficient of determination (strength)
Trendline
Strength
C64
2.6
5.2
7.0
6.0
6.2
7.5
7.6
6.2
5.3
6.0
y=3.542x0.337, R²=0.548
UW
strong
C65
0.7
0.3
-
0.6
-
0.3
-
0.3
0.3
0.3
y=0.604x-0.25, R²=0.438
DW
moderate
C66
-
-
-
0.3
-
-
0.7
-
0.3
0.2
y=0.301x0.206, R²=0.046
UW
weak
C67
5.1
8.2
6.6
7.0
5.4
5.6
5.0
4.9
4.8
5.8
y=6.802x-0.11, R²=0.205
DW
moderate
C68
-
0.3
-
-
-
-
-
-
-
0.04
-
-
N/A
C64-C68
8.4
14.1
13.6
14.0
11.6
13.5
13.4
11.5
10.8
12.3
y=10.88x0.077, R²=0.110
UW
weak
Males
C64
8.7
13.6
9.9
15.4
15.5
15.5
10.5
13.0
11.7
12.6
y=1.859x-0.47, R²=0.586
DW
strong
C65
-
1.2
-
-
1.2
0.6
-
-
0.6
0.4
y=0.849x-0.07, R²=0.009
DW
barely
C66
-
0.6
-
-
1.9
0.6
0.6
0.6
0.6
0.5
y=28.58x-0.01, R²=0.004
DW
barely
C67
25.3
33.4
32.8
23.4
22.8
35.8
30.9
22.2
28.4
28.3
-
-
N/A
C68
-
-
-
-
-
-
0.6
-
-
0.07
-
-
N/A
C64-C68
34.0
48.8
42.6
38.9
41.4
52.5
42.6
35.9
41.4
42.0
y=39.44x0.038, R²=0.041
UW
weak
Both genders
C64
5.3
8.6
8.2
10.1
10.1
10.8
8.6
9.3
7.8
8.8
y=0.180x0.417, R²=0.149
UW
weak
C65
0.4
0.7
-
0.3
0.5
0.5
-
0.2
0.5
0.4
y=15.69x-0.04, R²=0.032
DW
weak
C66
-
0.2
-
0.2
0.7
0.3
0.7
0.2
0.4
0.3
-
-
N/A
C67
13.5
18.3
17.4
13.5
12.2
17.8
15.9
11.9
14.5
15.0
-
-
N/A
C68
-
0.2
-
-
-
-
0.2
-
-
0.05
-
-
N/A
C64-C68
19.3
28.2
25.5
24.1
23.5
29.4
25.5
21.6
23.3
24.5
y=22.84x0.043, R²=0.059
UW
weak
"-" - to small number of cases
DW - downward
UW - upward
R² - relationship
N/A - not available
Table 3: The age-standardized incidence rate (ASIR) in the OBC for malignant neoplasms of urinary tract (C64-C68) per 100,000 using EU standard population, period 2001-2009.
Females
ICD-10
2001
2002
2003
2004
2005
2006
2007
2008
2009
2001-2009
Coefficient of determination (strength)
Trendline
Strength
C64
2.2
2.3
2.3
3.3
1.0
2.7
2.7
6.3
2.2
2.8
y=2.032x0.154, R²=0.057
UW
weak
C65
0.3
0.3
-
1.0
-
-
-
1.0
-
0.3
y=0.310x0.620, R²=0.831
UW
very strong
C66
-
-
-
-
-
-
0.3
-
0.3
0.1
-
-
N/A
C67
2.9
2.4
2.4
1.4
4.4
2.7
3.8
2.4
2.4
2.8
y=2.506x0.039, R²=0.007
UW
barely
C68
-
-
-
-
-
-
-
0.3
-
0.04
-
-
N/A
C64-C68
5.5
5.1
4.7
5.6
5.5
5.4
6.9
10.2
5.0
6.0
y=4.841x0.130, R²=0.160
UW
weak
Males
C64
6.8
5.5
5.5
6.2
11.1
8.0
6.8
7.4
8.1
7.3
y=5.897x0.131, R²=0.190
UW
moderate
C65
-
0.6
-
-
0.6
-
-
0.6
1.2
0.3
y=0.479x0.263, R²=0.271
UW
moderate
C66
-
0.6
-
0.6
-
0.6
-
0.6
0.6
0.3
y=0.608x0.007, R²=0.270
UW
moderate
C67
13.0
10.5
11.7
16.6
19.1
17.2
15.4
15.4
13.5
14.7
y=11.82x0.141, R²=0.281
UW
moderate
C68
-
-
-
-
-
-
0.6
-
-
0.1
-
-
N/A
C64-C68
19.8
17.3
17.3
23.4
30.8
25.9
22.7
24.0
23.4
22.7
y=17.91x0.156, R²=0.360
UW
moderate
Both genders
C64
4.4
3.7
3.6
4.5
5.1
4.9
4.2
6.6
4.7
4.6
y=3.745x0.135, R²=0.281
UW
moderate
C65
0.2
0.5
-
0.5
0.3
-
-
0.9
0.5
0.3
y=0.271x0.386, R²=0.449
UW
moderate
C66
-
0.2
-
0.2
-
0.2
0.2
0.2
0.5
0.2
y=0.160x0.281, R²=0.202
UW
moderate
C67
6.9
5.8
6.0
7.1
9.9
8.1
8.1
7.4
6.5
7.3
y=6.343x0.092, R²=0.163
UW
moderate
C68
-
-
-
-
-
-
0.2
0.2
-
0.05
-
-
N/A
C64-C68
11.5
10.2
9.6
12.4
15.3
13.3
12.7
15.3
12.2
12.5
y=10.27x0.130, R²=0.350
UW
moderate
"-" - to small number of cases
DW - downward trendline
UW - upward trendline
R - relationship
N/A - not available
Table 4: The age-standardized mortality rate (ASMR) in the OBC for malignant neoplasms of urinary tract (C64-C68) per 100,000 using EU standard population, period 2001-2009.
Overall incidence rate/100,000 EU population
Overall mortality rate/100,000 EU population
Age group
2001-2009
COD(S)
Trendline
Strength
2001-2009
COD(S)
Trendline
Strength
Females
0-19
0.3
N/A
-
-
0.0
N/A
-
N/A
20-44
2.3
y=2.035x0.110, R²=0.034
-
-
0.8
N/A
-
N/A
45-64
18.0
y=10.03x0.346, R²=0.231
UW
Moderate
4.7
y=3.398x0.184, R²=0.047
UW
weak
65+
62.9
y=63.20x-0.00, R²=0.002
DW
Slightly
41.3
y=29.56x0.214, R²=0.371
UW
moderate
Males
0-19
0.3
N/A
-
-
0.0
N/A
-
N/A
20-44
3.6
y=2.053x0.313, R²=0.184
UW
Moderate
0.6
N/A
-
N/A
45-64
62.3
y=63.32x-0.01, R²=0.007
DW
Slightly
19.5
y=31.17x-0.4, R²=0.296
DW
moderate
65+
228.1
y=206.4x0.060, R²=0.060
UW
Slightly
160.6
y=94.97x0.341, R²=0.658
UW
strong
Both genders
0-19
0.0
N/A
-
-
0.0
N/A
-
N/A
20-44
3.0
y=2.071x0.182, R²=0.077
UW
Slightly
0.7
y=0.861, R²=-8E-1
DW
barely
45-64
39.4
y=37.32x0.030, R²=0.019
UW
Slightly
11.8
y=16.77x-0.32, R²=0.155
DW
weak
65+
122.9
y=115.5x0.036, R²=0.031
UW
Slightly
84.6
y=53.58x0.300, R²=0.687
UW
strong
COD(S) - Coefficient of determination (strength)
DW - downward trendline
UW - upward trendline
"-" - to small number of cases
N/A - not available
Table 5: The age-standardized incidence rate (ASIR) and the age-standardized mortality rate (ASMR) in relation with age group of the OBC cancer patients of malignant neoplasms of urinary tract (C64-C68), period 2001-2009.
Every year, an average of 52.3 patients died of C64-C68 cancers in the OBC, which implies the overall age-standardized mortality rate (ASMR) of 12.5/100,000. Both genders seeing as a whole experienced a moderate upward trend line in the mortality rate (R2=0.350, SD±1.74, CI 9.09-15.91) (Tables 2,4,5). A rise in the mortality rates from the malignant neoplasm of kidney (C64) and bladder (C67) in both genders resulted from an increase in the mortality rates from these cancers in males. The mortality rate from C64-C68 cancers was about eight patients in both genders separately. In males, the ASMR strongly increased in age group 65+ years (R2=0.658, Table 5), not only to the whole group, but also to the each cancer sites of this cancer group.
The age-adjusted 5-year relative survival rate of all OBC patients from C64-C68 cancers totalled 51.0% in 2001-2005 period (Table 6, Figure 3). The survival rate in males resembled the overall survival rate and it was slightly higher than in females (51.1% in males and 50.6% in females). Males aged 20-44 had a lower survival rate (58.4%) then males aged 45-64 (62.0%). This difference emerged due to the survival rate from renal pelvis cancer (C64) which amounted to only 37.5% in males aged 20-44. Female patients aged 65+ (36.7%) had two times slimmer chances to survive these cancers than younger females did (71.5% and 80.4%, respectively). Such differences characterize all sites of this cancer group. The survival rate from kidney cancer (C64) was fairly higher in females (54.0%) than in males (42.7%). The situation was different with bladder cancer (C67) since males seemed to be more survival to it (55.4%) than females (49.3%).
Figure 3: The age-standardized 5-year relative survival rate for cancer group C64-C68 (both genders) combined by age in the OBC in the 2001-2005 period. For cancer site C64 in females, the rising trendline suggest that a strong relationship exists between 5-years survival rate and years, R2=0.495 (R2>0.48<0.81).
Age group
ICD-10
0-19
20-44
45-64
65+
All ages
Females - % of survival (number of survival cases)
C64
-
-
100.1
(3)
79.1
(18)
34.5
(11)
54.0
(32)
C65
-
-
0.0
-
-
-
35.5
(1)
25.3
(1)
C66
-
-
-
-
-
-
0.0
-
0.0
-
C67
-
-
66.7
(2)
81.8
(17)
37.5
(19)
49.3
(38)
C68
-
-
-
-
-
-
106.6
(1)
101.3
(1)
C64-C68
-
-
71.5
(5)
80.4
(35)
36.7
(32)
50.6
(72)
Males - % of survival (number of survival cases)
C64
100.1
(1)
37.5
(3)
55.7
(27)
29.1
(12)
42.7
(43)
C65
-
-
-
-
0.0
-
53.3
(1)
25.3
(1)
C66
-
-
-
-
101.0
(1)
35.5
(1)
50.6
(2)
C67
-
-
100.1
(4)
66.9
(53)
49.8
(65)
55.4
(122)
C68
-
-
-
-
-
-
-
-
-
-
C64-C68
100.1
(1)
58.4
(7)
62.0
(81)
44.8
(79)
51.1
(168)
Both genders - % of survival (number of survival cases)
C64
100.1
(1)
54.6
(6)
63.1
(45)
31.4
(23)
46.9
(75)
C65
-
-
0.0
-
0.0
-
42.6
(2)
25.3
(2)
C66
-
-
-
-
101.0
(1)
26.6
(1)
40.5
(2)
C67
-
-
85.8
(6)
70.0
(70)
46.4
(84)
53.8
(160)
C68
-
-
-
-
-
-
106.6
(1)
101.3
(1)
C64-C68
100.1
(1)
63.2
(12)
66.6
(116)
42.1
(111)
51.0
(240)
"-" - No cases
0.0 - No survival cases
Table 6: Five years relative survival rates (in %) for malignant neoplasms of urinary tract (C64-C68) cancers in the OBC, both genders, period 2001-2005.
The age distribution at diagnosis and at death from C64-C68 cancers is shown in Tables 7,8 and Figure 4. Out of the entire corpus of patients, 59.1% and 77.9% of them were aged 65+ at diagnosis and at death, respectively. Female patients aged 65+ made up 65.0% and 83.5% of all female C64-C68 cancer patients at diagnosis and at death, respectively. This percentage in males was 56.5% and 75.6%, respectively. Patients under 45 years of age constituted only 3.9% and 2.5% of the entire corpus of patients diagnosed with C64-C68 cancers, respectively.
Figure 4: The age distribution for malignant neoplasms of urinary tract (C64-C68) in the period 2001-2009, both genders.
Table 7.1
Both genders
Males
Females
ICD-10
Age
2001-2009
(%)Trend
lineStrength
2001-2009
(%)Trend
lineStrength
2001-2009
(%)Trend
lineStrength
C64
0-19
0,7
N/A
-
0,5
N/A
-
0,8
N/A
-
20-44
6,3
DW
weak
6,5
DW
moderate
5,9
DW
moderate
45-64
45,0
DW
barely
48,9
DW
barely
39,0
UW
weak
65+
48,0
UW
barely
44,0
UW
barely
54,2
DW
barely
C65
20-44
7,7
N/A
-
0,0
N/A
-
14,3
N/A
-
45-64
30,8
UW
very strong
66,7
N/A
-
0,0
N/A
-
65+
61,5
DW
moderate
33,3
N/A
-
85,7
N/A
-
C66
45-64
41,7
UW
strong
37,5
N/A
-
50,0
N/A
-
65+
58,3
DW
barely
62,5
N/A
-
50,0
N/A
-
C67
20-44
2,6
UW
barely
2,2
UW
weak
3,8
UW
weak
45-64
32,4
DW
weak
35,6
DW
barely
22,3
DW
weak
65+
65,0
DW
barely
62,2
DW
barely
73,8
UW
barely
C68
65+
0,2
N/A
-
100,0
N/A
-
100,0
N/A
-
C64-C68
0-19
0,2
N/A
-
0,2
N/A
-
0,4
N/A
-
20-44
3,9
UW
weak
3,4
UW
weak
5,0
UW
weak
45-64
36,8
UW
barely
39,9
DW
barely
29,6
UW
weak
65+
59,1
DW
weak
56,5
DW
barely
65,0
DW
weak
Table 7.2
C64
All
ages34,6
UW
moderate
30,1
UW
weak
45,4
UW
strong
C65
1,5
DW
moderate
1,0
DW
moderate
2,7
DW
moderate
C66
1,4
UW
moderate
1,3
UW
barely
1,5
UW
moderate
C67
62,3
DW
moderate
67,5
DW
weak
50,0
DW
strong
C68
0,2
N/A
-
0,2
N/A
-
0,4
N/A
-
Table 7.3
The age proportion of each cancer site
0-44
45-64
65+
All ages
BG
F
M
BG
F
M
BG
F
M
BG
F
M
C64
2,4
3,1
2,1
15,6
17,7
14,7
16,6
24,6
13,2
34,6
45,4
30,1
C65
0,1
0,4
0,0
0,5
0,0
0,7
0,9
2,3
0,3
1,5
2,7
1,0
C66
0,0
0,0
0,0
0,6
0,8
0,5
0,8
0,8
0,8
1,4
1,5
1,3
C67
1,6
1,9
1,5
20,2
11,2
24,0
40,5
36,9
42,0
62,3
50,0
67,5
C68
0,0
0,0
0,0
0,0
0,0
0,0
0,2
0,4
0,2
0,2
0,4
0,2
C64-C68
4,1
5,4
3,6
36,8
29,6
39,9
59,1
65,0
56,5
100
100
100
N/A - not available Coefficient of determination (strength) - COD(S)
DW - downward trendline
UW - upward trendline
"-" - to small number of cases
Table 7: The age distribution at diagnosis for malignant neoplasms of urinary tract (C64-C68) in the OBC, period 2001-2009.
Table 8.1
Both genders
Males
Females
ICD-10
Age
2001-2009
(%)Trend
lineStrength
2001-2009
(%)Trend
lineStrength
2001-2009
(%)Trend
lineStrength
C64
20-44
6,0
DW
weak
7,5
UW
weak
3,3
N/A
-
45-64
27,5
DW
weak
30,2
DW
weak
23,0
UW
moderate
65+
66,5
UW
moderate
62,3
UW
moderate
73,8
UW
barely
C65
20-44
8,3
N/A
-
0,0
N/A
-
14,3
N/A
-
45-64
25,0
UW
barely
60,0
DW
strong
0,0
N/A
-
65+
66,7
DW
weak
40,0
N/A
-
85,7
DW
weak
C66
45-64
14,3
N/A
-
20,0
N/A
-
0,0
N/A
-
65+
85,7
DW
moderate
80,0
N/A
-
100,0
N/A
-
C67
20-44
0,4
N/A
-
0,0
N/A
-
1,5
N/A
-
45-64
14,8
DW
strong
11,1
DW
strong
7,4
DW
strong
65+
84,8
UW
very strong
53,6
UW
strong
91,2
UW
moderate
C68
65+
100,0
N/A
-
100,0
N/A
-
100,0
N/A
-
C64-C68
20-44
2,5
DW
weak
2,4
UW
weak
2,9
DW
moderate
45-64
19,5
DW
strong
22,0
DW
strong
13,7
DW
barely
65+
77,9
UW
strong
75,6
UW
very strong
83,5
UW
weak
Table 8.2
The proportion trendline of each cancer site in relation to the gender
C64
All
ages35,5
DW
barely
31,9
DW
weak
43,9
UW
barely
C65
2,5
UW
weak
1,5
UW
barely
5,0
UW
strong
C66
1,5
UW
barely
1,5
DW
strong
1,4
N/A
-
C67
60,1
DW
weak
64,8
DW
barely
48,9
DW
barely
C68
0,4
N/A
-
0,3
N/A
-
0,7
N/A
-
Table 8.3
The proportion of each cancer site
0-44
45-64
65+
All ages
BG
F
M
BG
F
M
BG
F
M
BG
F
M
C64
2,1
1,4
2,4
9,8
10,1
9,6
23,6
32,4
19,9
35,5
43,9
31,9
C65
0,2
0,7
0,0
0,6
0,0
0,9
1,7
4,3
0,6
2,5
5,0
1,5
C66
0,0
0,0
0,0
0,2
0,0
0,3
1,3
1,4
1,2
1,5
1,4
1,5
C67
0,2
0,7
0,0
8,9
3,6
11,1
51,0
44,6
53,6
60,1
48,9
64,8
C68
0,0
0,0
0,0
0,0
0,0
0,0
0,4
0,7
0,3
0,4
0,7
0,3
C64-C68
2,5
2,9
2,4
19,5
13,7
22,0
77,9
83,5
75,6
100
100
100
N/A - not available Coefficient of determination (strength) - COD(S)
DW - downward trendline
UW - upward trendline
"-" - to small number of cases
Table 8: The age distribution at death for malignant neoplasms of urinary tract (C64-C68) in the OBC, period 2001-2009.
In the 2001-2009 period, a total of 872 people were diagnosed with C64-C68 cancers and they were admitted to the OBC hospitals 2,350 times where they spent a total of 26,649 days. An average patient was admitted to hospital 2.7 times during the course of their illness with the average length of stay in hospital (LOSH) of 11.3 days (Table 9,11). The number of hospitalizations was largest in the 65+ age category (1,443/2,350, 61.4%). Female patients accounted for 25.2% of all hospitalizations and they spent an average of 12.4 days in hospital, which is 1.4 days longer than the average stay in hospital in males (11.0 days). Females aged 65+ (12.4 days) stayed longer in hospital by 1.2 days on average than males of the same age did (11.2 days).
Ages
0-19
20-44
45-64
65+
All ages
0-19
20-44
45-64
65+
All ages
Females - NOAH
Females - average LOSH
C64
5
7
81
83
176
6.6
16.7
17.5
15.7
16.3
C65
-
1
1
8
10
-
12.0
51.0
21.0
23.1
C66
-
-
3
7
10
-
-
8.0
24.3
19.4
C67
-
22
112
260
394
-
9.9
9.0
10.8
10.2
C68
-
1
-
1
2
-
8.0
-
14.0
11.0
C64-C68
6.6
11.5
12.7
12.4
12.4
Males - NOAH
Males - average LOSH
C64
1
20
130
112
263
9.0
17.1
17.1
16.6
16.9
C65
-
-
7
4
11
-
-
17.7
32.0
22.9
C66
-
-
5
11
16
-
-
13.2
22.3
19.4
C67
-
35
476
955
1466
-
4.8
8.9
10.3
9.7
C68
-
-
-
2
2
-
-
-
15.0
15.0
C64-C68
9.0
9.3
10.8
11.2
11.0
Both genders - NOAH
Both genders - average LOSH
C64
6
27
211
195
439
7.0
17.0
17.2
16.2
16.6
C65
-
1
8
12
21
-
12.0
21.9
24.7
23.0
C66
-
-
8
18
26
-
-
11.3
23.1
19.4
C67
-
57
588
1215
1860
-
6.8
8.9
10.4
9.8
C68
-
1
-
3
4
-
8.0
-
14.7
13.0
C64-C68
7.0
10.1
11.2
11.5
11.3
"-" - No cases
NOAH - number of hospital admissions
LOSH - length of stay in hospital
Table 9: The number of cancer hospitalizations and the average length of stay in hospital for malignant neoplasms of urinary tract (C64-C68) in the period 2001-2009.
Year
Females - NOAH
Females - average LOSH
0-19
20-44
45-64
65+
All ages
0-19
20-44
45-64
65+
All ages
2001
-
1
17
25
43
-
7.0
8.8
10.4
9.7
2002
2
2
19
35
58
6.0
9.5
16.7
16.2
15.8
2003
1
12
22
28
63
9.0
5.6
11.5
21.6
14.8
2004
-
6
22
41
69
-
6.2
17.1
14.1
14.4
2005
-
1
24
54
79
-
13.0
11.2
12.1
11.8
2006
2
-
22
51
75
6.0
-
12.5
12.6
12.4
2007
-
3
36
41
80
-
31.3
10.1
8.5
10.1
2008
-
4
21
42
67
-
18.3
15.6
8.7
11.4
2009
-
2
14
42
58
-
22.5
11.4
10.5
11.1
2001-2009
6.6
11.5
12.7
12.4
12.4
COD(S) - R2=
0.022
0.050
0.061
0.579
0.520
0.022
0.0539
0.033
0.161
0.022
Trendline
UW
UW
UW
UW
UW
DW
UW
UW
DW
DW
Year
Males - NOAH
Males - average LOSH
0-19
20-44
45-64
65+
All ages
0-19
20-44
45-64
65+
All ages
2001
-
4
64
71
139
-
7.0
10.1
11.6
10.8
2002
-
7
64
99
170
-
17.6
12.9
15.0
14.3
2003
-
1
51
100
152
-
4.0
15.4
13.1
13.8
2004
-
13
57
109
179
-
9.8
9.6
10.3
10.0
2005
1
5
53
138
197
9.0
8.2
16.1
10.3
11.8
2006
-
3
77
177
257
-
12.7
10.4
11.6
11.3
2007
-
8
75
149
232
-
8.6
7.6
10.3
9.4
2008
-
3
107
94
204
-
10.0
8.2
9.5
8.8
2009
-
11
70
147
228
-
4.5
10.9
10.0
10.0
2001-2009
9.0
9.3
10.8
11.2
11.0
COD(S) - R2=
N/A
0.038
0.211
0.55
0.740
N/A
0.008
0.088
0.426
0.291
Trendline
-
UW
UW
UW
UW
-
DW
DW
DW
DW
Year
Both genders - NOAH
Both genders - LOSH
0-19
20-44
45-64
65+
All ages
0-19
20-44
45-64
65+
All ages
2001
-
5
81
96
182
-
7.0
9.8
11.3
10.5
2002
2
9
83
134
228
6.0
15.8
13.7
15.3
14.7
2003
1
13
73
128
215
9.0
5.5
14.2
15.0
14.1
2004
-
19
79
150
248
-
8.6
11.7
11.3
11.2
2005
1
6
77
192
276
9.0
9.0
14.5
10.8
11.8
2006
2
3
99
228
332
6.0
12.7
10.9
11.8
11.5
2007
-
11
111
190
312
-
14.8
8.4
9.9
9.6
2008
-
7
128
136
271
-
14.7
9.4
9.2
9.4
2009
-
13
84
189
286
-
7.3
11.0
10.1
10.2
2001-2009
7.0
10.1
11.2
11.5
11.3
COD(S) - R2=
0.016
0.017
0.281
0.606
0.777
0.016
0.088
0.066
0.348
0.228
Trendline
DW
UW
UW
UW
UW
UW
UW
DW
DW
DW
"-" - No cases
NOAH - number of hospital admissions
LOSH - Length of stay in hospital
COD(S) - coefficient of determination
R - relationship
N/A - not available
UW - upward trendline
DW - downward trendline
Table 10: The years of diagnosis and the average length of stay in hospital and number of hospital admissions for malignant neoplasms of urinary tract (C64-C68) in the OBC, period 2001-2009.
Females
C64
C67
C64-C68
Year
NOAH
N
AAH
LOSH
NOAH
N
AAH
LOSH
NOAH
N
AAH
LOSH
2001
6
6
1.0
10.0
34
14
2.4
8.7
43
22
2.0
9.7
2002
18
10
1.8
24.6
38
20
1.9
11.1
58
32
1.8
15.8
2003
17
16
1.1
16.4
46
16
2.9
14.2
63
32
2.0
14.8
2004
20
13
1.5
17.4
45
16
2.8
12.2
69
31
2.2
14.4
2005
18
15
1.2
13.4
58
12
4.8
10.3
79
27
2.9
11.8
2006
31
17
1.8
15.7
43
14
3.1
9.9
75
32
2.3
12.4
2007
25
17
1.5
15.8
52
13
4.0
7.5
80
32
2.5
10.1
2008
23
13
1.8
16.5
41
12
3.4
8.6
67
26
2.6
11.4
2009
18
11
1.6
13.2
37
13
2.8
9.2
58
26
2.2
11.1
2001-2009
176
118
1.5
16.3
394
130
3.0
10.2
592
260
2.3
12.4
COD(S) - R2=
0.639
0.502
0.318
0.015
0.177
0.316
0.364
0.077
0.520
0.069
0.476
0.022
Trendline
UW
UW
UW
UW
UW
DW
UW
DW
UW
UW
UW
DW
Males
C64
C67
C64-C68
Year
NOAH
N
AAH
LOSH
NOAH
N
AAH
LOSH
NOAH
N
AAH
LOSH
2001
18
14
1.3
11.7
120
41
2.9
10.5
139
55
2.5
10.8
2002
29
22
1.3
18.7
137
54
2.5
12.8
170
79
2.2
14.3
2003
19
16
1.2
19.1
132
53
2.5
13.1
152
69
2.2
13.8
2004
32
25
1.3
16.8
146
38
3.8
8.5
179
63
2.8
10.0
2005
36
25
1.4
20.7
156
37
4.2
9.3
197
67
2.9
11.8
2006
39
25
1.6
16.0
211
58
3.6
10.0
257
85
3.0
11.3
2007
24
17
1.4
16.6
205
50
4.1
8.5
232
69
3.4
9.4
2008
32
21
1.5
15.3
170
36
4.7
7.6
204
58
3.5
8.8
2009
34
19
1.8
15.4
189
46
4.1
9.0
228
67
3.4
10.0
2001-2009
263
184
1.4
16.9
1466
413
3.5
9.7
1758
612
2.9
11.0
COD(S) - R2=
0.432
0.187
0.515
0.088
0.726
0.003
0.610
0.415
0.740
0.042
0.652
0.291
Trendline
UW
UW
UW
UW
UW
DW
UW
DW
UW
UW
UW
DW
Both genders
C64
C67
C64-C68
Year
NOAH
N
AAH
LOSH
NOAH
N
AAH
LOSH
NOAH
N
AAH
LOSH
2001
24
20
1.2
11.3
154
55
2.8
10.1
182
77
2.4
10.5
2002
47
32
1.5
21.0
175
74
2.4
12.4
228
111
2.1
14.7
2003
36
32
1.1
17.8
178
69
2.6
13.4
215
101
2.1
14.1
2004
52
38
1.4
17.0
191
54
3.5
9.4
248
94
2.6
11.2
2005
54
40
1.4
18.3
214
49
4.4
9.6
276
94
2.9
11.8
2006
70
42
1.7
15.9
254
72
3.5
10.0
332
117
2.8
11.5
2007
49
34
1.4
16.2
257
63
4.1
8.3
312
101
3.1
9.6
2008
55
34
1.6
15.8
211
48
4.4
7.8
271
84
3.2
9.4
2009
52
30
1.7
14.7
226
59
3.8
9.1
286
93
3.1
10.2
2001-2009
439
302
1.5
16.6
1860
543
3.4
9.8
2350
872
2.7
11.3
COD(S) - R2=
0.647
0.435
0.493
0.048
0.760
0.035
0.662
0.368
0.777
0.055
0.668
0.228
Trendline
UW
UW
UW
UW
UW
DW
UW
DW
UW
UW
UW
DW
NOAH - number of hospital admissions
N - number of cases
AAH - average admission in hospital per patient
LOSH - length of stay in hospital
DW - downward trendline
UW - upward trendline
COD(S) - R - coefficient of determination (strength) - Relationship
Table 11: The years of diagnosis and trendlines of the average admission in hospital, the average length of stay in hospital and the number of admission in hospital per patient for selected malignant neoplasms of urinary tract (C64-C68) in the OBC, period 2001-2009.
The number of admission in hospital (NOAH) in years 2001 to 2009 progressively grew, both from the viewpoint of the entire population of patients and seeing genders separately (R2=0.777) (Tables 10,11, Figure 5). Taking account of both genders together and each of them separately, the first three years of the first period (2001- 2003) reflected a sharp rise in the LOSH while the second period (2004-2009) was marked by a decline in this parameter (moderate downward trend line, R2=0.228).
Figure 5: Length of stay in hospital (LOSH) (in days) for cancer group C64-C68 (both genders, selected sites) in the OBC in the 2001-2009 period (NOAH - number of hospital admissions). The rising trendlines in both genders for whole cancer group suggests that very strong relationships exist between the NOAH and years (R2=0.520 and R2=0.740, respectively (R2>0.48<0.81) and moderate downward trendline exist in males between the LOSH and years, R2=0.291. NOAH - number of hospital admissions, LOSH - length of stay in hospital.
In the period from 2001 to 2009 years slightly increases the incidence rate, and moderate increases mortality rate. In female's slowly rising relative 5-year survival and in males it gently decrease. The number of admission in hospital and the average admission in hospital per patient strongly increased, while in the same period moderately decreased the average length of stay in hospital.
Discussion
Every year during the 2001-2009 periods, an average of around 97 people were diagnosed with C64-C68 cancers in the OBC. In the same period, an annual average of registered deaths from this cancer group numbered around 52. These cancers accounted for around 1 in 16 cancer registrations and 1 in 18 cancer deaths in the OBC [1]. There was a weak increase in the age-standardised incidence rate of C64-C68. The estimated bladder and kidney cancer incidence varied widely throughout Europe in 2008. The average European kidney cancer (C64) incidence rate of 12.1/100,000 and the average incidence rate of this type of cancer at the Croatian level of 13.8/100,000 were higher by 1/3 than this incidence rate in the OBC (8.8/100,000). Unfortunately, the incidence rate of kidney cancer strongly increases in the age group 45-64 years and moderate increases in the age group 65+ years (Table 3). For now there are not available explanations for such changes. The kidney cancer mortality rate in the OBC (4.6/100,000) was lower than the mortality rate from this cancer site in Europe and that at the Croatian level (4.7 and 5.8/100,000, respectively), too [16].
The urinary bladder incidence rate in the OBC (15.0/100,000) was a little higher than the respective incidence rate in Europe but it stayed below the Croatian average (14.4 and 16.2/100,000, respectively) while the mortality rate (7.3/100,000) from this cancer site exceeded the appertaining mortality rates in both Europe and Croatia [16-18].
Despite the fact that the 5-year relative survival rate from urinary bladder cancer (C67) in the OBC was higher in males (55.4%) than in females (49.3%) (The ratio between genders in the OBC resembled the one in Europe), the survival rate in males was still lower than that at the European (73% in males and 69% in females) [19], and Croatian level (75% in males and 76% in females) [16,20]. The survival rate from kidney cancer (42.7%) in males was lower in the OBC than in Croatia as a whole by 13.3 percentage points (Croatian average - males 56%) and in females, it was 11 percentage points lower than that in Croatia (65%). Kidney cancer in the OBC was most fatal in the 65+ group (31.4%).
Although they were mandatory, the data on the length of stay in hospital (LOSH) and number of hospital admissions (NOAH) per C64-C68 cancer patient cannot be related and compared with performed medical treatments during the hospital care. The data suggest that the NOAH strongly increased from 2001 to 2009. A rapid rise in the length of stay in hospital was registered in 2005 and 2007 when this figure jumped with respect to the previous and following year despite no bigger change in the number of newly registered cases of C64-C68 cancers in the same years and thus this increase remains unclear. Moreover, the data on the average LOSH (moderate downward) and NOHA (strongly upward) cannot be connected with the rise in the mortality rate from this cancer group either because trend line was moderate upward (in both genders).
Conclusion
Although the data on the incidence and mortality rate from this cancer group do not deviate much from the corresponding data on the European and Croatian level, the relative 5-years survival rate, as a direct indicator of the quality of the health, is far below the EU average and thus directly suggests that the health care of these cancer patients in the OBC should be substantially improved and put on a much higher level. Due to the lack of data on the stage of the cancer, about the treatment of cancer and about other indicators related with the cancer, at this time it is not possible to explain (without speculation) why that difference exist.
Limitation
Patients who were treated outside the two state-owned (public) hospitals in the OBC are not registered with the IPHO. Despite the efforts to obtain this information (they exist at the national level) in their original form, the authors were unable to obtain that data for unknown reasons. Therefore, these data on cancer in the OBC may differ from the official state data on cancer in the OBC.
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