Premature cancer morbidity and mortality conditions through the epidemiological transitions and the global smoking epidemic. The case of Hungary, Austria and Denmark

Abstract

Background: Hungary has the highest mortality rates in cancer all over the World and this goes along with high-ratio of premature deaths in the middle-aged population, in which smoking plays a proven and significant role. This imposes not just heavy emotional and financial burdens on the society, but also considerably slows down the upward trend in life expectancy The aim of this dissertation is to better understand this unfavorable health situation in Hungary especially in the epidemiological renewal from 1994 to 2015. All of this is based on the available data, applying statistical methods and using Austria and Denmark as a benchmark. Methods: The dissertation begins with a review of the theoretical background and classifies the countries according to the human longevity considerations. Then applies explorative and descriptive data analysis with international outlook: Preston-curve for 2015 and time-path plots (life expectancy vs life-span equality) by sex and age from a historical perspective between 1950 and 2014. This is followed by the examination of the potential years of life lost indicator and the life table decomposition, all by sex, age and main and cancer causes of death. The survival analysis follows all of the cancer cases from 2013 to mid-2015 by sex, age and exact localizations of cancer and then with the help of curve fitting defines the life expectancy at diagnosis for the same breakdowns. The runoff of the global smoking epidemic is examined by the historical time series data of smoking prevalence and mortality for USA, Hungary and Austria. Thereafter, the smoking-attributable excess mortality is calculated for Hungary by sex, age and causes of deaths in the period 2000-2015. Results: In Hungary the GDP is half as much compared to the Austrian and Danish value and the life expectancy is approx. 5 year shorter, which can be considered a bad legacy of the socialist system. The cardiovascular revolution which appeared more than three decades later in Hungary than in Austria and Denmark, led the masses with vulnerable health status towards the cancer mortality in the epidemiological renewal. In the period 1994-2015, there was improvement in the under age 50 population in smoking related cancers, no changes in the high mortality of breast, colon and gynecological cancers, in contrast with the decline in Austria and Denmark and significant deterioration can be observed in smoking-related cancers among 50-75 year-old women. At the same time, among others, the women in their 50s who were diagnosed with breast cancer in 2013, lived only the two-third of the older 60-79 year-old female patients’ life. Meanwhile, both the prevalence and mortality of women in the global smoking epidemic increased in Hungary and Austria, in contrast with men. According to the calculation of the smoking-attributable mortality, the smoking-attributable standardized death rate due to trachea, bronchus and lung cancers per 100 000 women grew drastically, by 60% from 2000 to 2014 and it is explained by the worsening mortality rate of 50-70-year-old women. Conclusions: The epidemiological crisis character of socialist systems and its negative wave caused the cancer crisis in Hungary in the new health era. Between 1994 and 2015 a significant catch-up in middle-age mortality (mostly related to smoking) can be observed compared to Austria and Denmark, but no sign of similar process in old-age. The ‘triangle’ of breast, lung, and colon cancers are the major contributors to the high premature cancer mortality. The indicator of life expectancy at diagnosis is able to identify early invasive cancers by sex, age and localization of cancer. The global smoking epidemic was the most destructive among Hungarian men and in case of women increasing values and strong negative cohort effects among Hungarian and Austrian middle-aged population is identified due to smoking and also a full recovery from this in Denmark. Nevertheless, compared to the USA, Austrian and Hungarian societies may be characterized by more traditional gender roles and associated cultural norms, all of this may have reduced the harmful effects of the cigarette epidemic to Central European women.