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1.  Premature mortality in Belgium in 1993-2009: leading causes, regional disparities and 15 years change 
Archives of Public Health  2014;72(1):34.
Background
Reducing premature mortality is a crucial public health objective. After a long gap in the publication of Belgian mortality statistics, this paper presents the leading causes and the regional disparities in premature mortality in 2008–2009 and the changes since 1993.
Methods
All deaths occurring in the periods 1993–1999 and 2003–2009, in people aged 1–74 residing in Belgium were included.
The cause of death and population data for Belgium were provided by Statistics Belgium , while data for international comparisons were extracted from the WHO mortality database.
Age-adjusted mortality rates and Person Year of Life Lost (PYLL) were calculated. The Rate Ratios were computed for regional and international comparisons, using the region or country with the lowest rate as reference; statistical significance was tested assuming a Poisson distribution of the number of deaths.
Results
The burden of premature mortality is much higher in men than in women (respectively 42% and 24% of the total number of deaths). The 2008–9 burden of premature mortality in Belgium reaches 6410 and 3440 PYLL per 100,000, respectively in males and females, ranking 4th and 3rd worst within the EU15. The disparities between Belgian regions are substantial: for overall premature mortality, respective excess of 40% and 20% among males, 30% and 20% among females are observed in Wallonia and Brussels as compared to Flanders. Also in cause specific mortality, Wallonia experiences a clear disadvantage compared to Flanders. Brussels shows an intermediate level for natural causes, but ranks differently for external causes, with less road accidents and suicide and more non-transport accidents than in the other regions.
Age-adjusted premature mortality rates decreased by 29% among men and by 22% among women over a period of 15 years. Among men, circulatory diseases death rates decreased the fastest (-43.4%), followed by the neoplasms (-26.6%), the other natural causes (-21.0%) and the external causes (-20.8%). The larger decrease in single cause is observed for stomach cancer (-48.4%), road accident (-44%), genital organs (-40.4%) and lung (-34.6%) cancers. On the opposite, liver cancer death rate increased by 16%.
Among female, the most remarkable feature is the 50.2% increase in the lung cancer death rate. For most other causes, the decline is slightly weaker than in men.
Conclusion
Despite a steady decrease over time, international comparisons of the premature mortality burden highlight the room for improvement in Belgium. The disadvantage in Wallonia and to some extent in Brussels suggest the role of socio-economic factors; well- designed health policies could contribute to reduce the regional disparities. The increase in female lung cancer mortality is worrying.
doi:10.1186/2049-3258-72-34
PMCID: PMC4200135  PMID: 25328677
Premature mortality; Mortality rates; Potential Years of Life Lost; Causes of death; Belgium
2.  High burden of breast cancer in Belgium: recent trends in incidence (1999-2006) and historical trends in mortality (1954-2006) 
Introduction
In Belgium, breast cancer mortality has been monitored since 1954, whereas cancer incidence data have only been made available for a few years. In this article we update historical trends of breast cancer mortality and describe the recent breast cancer incidence.
Methods
Incidence data were extracted from the Belgium Cancer Registry from 2004 to 2006 for the Walloon and Brussels Regions and Belgium, and from 1999 to 2006 for the Flemish Region. The Directorate-general Statistics and Economic information provided the mortality data for the years 1954-1999 and 2004. The regional authorities of the Flemish and Brussels Regions provided the mortality data for the years 2000-2003 and 2005-2006.
Results
In 2004, the World age-standardised breast cancer incidence for the whole of Belgium was 110 per 100, 000 person-years for all ages; and 172, 390 and 345 per 100, 000 person-years for the 35-49, 50-69, and 70+ age groups, respectively. The incidence rate was slightly higher in each age group in the Brussels Region. In Flanders, where the incidence could be observed during a longer period, an increase was observed until 2003 in the 50-69 age group, followed by a decrease. To the contrary, in the oldest age group, incidence continued to rise over the whole period, whereas no change in incidence was observed between 1999 and 2006 in the 35-49 age group.
Mortality increased until the late 1980s and afterwards decreased in all regions and in age groups younger than 70. In women of 70 years and older, the decline began later.
Conclusions
The burden of breast cancer in Belgium is very high. In 2004, Belgium ranked first for the age-standardised incidence rate in Europe for all ages combined and in the 35-49 and 50-69 age groups. The impact of the known risk factors and of mammographic screening should be further studied. The mortality rate in Belgium ranked lower than incidence, suggesting favourable survival. Plausible explanations for the discrepancy between incidence and mortality are discussed.
doi:10.1186/0778-7367-69-2
PMCID: PMC3436615  PMID: 22958447

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