Incidence and mortality rates of lip, oral cavity, and pharynx cancers in Brazil: time-trend and age-period-cohort analysis from the last 30 years, Global Burden of Disease Study

Romagna, Daniel Volpato; Oliveira, Max Moura de; Abreu, Lucas Guimarães; Stein, Caroline; Hugo, Fernando Neves; Teixeira, Renato; Malta, Deborah Carvalho; Naghavi, Mohsen; Iser, Betine Pinto Moehlecke

doi:10.1590/0037-8682-0286-2021

Brasil

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Major Article • Rev. Soc. Bras. Med. Trop. 55 (suppl 1) • 2022 • https://doi.org/10.1590/0037-8682-0286-2021 linkcopy

Incidence and mortality rates of lip, oral cavity, and pharynx cancers in Brazil: time-trend and age-period-cohort analysis from the last 30 years, Global Burden of Disease Study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

INTRODUCTION: Cancers are the second main cause of morbidity worldwide, but robust information on lip, oral cavity, and pharynx cancers in Brazil is lacking. This study aimed to analyze the trends of incidence and mortality caused by lip, oral cavity, and pharynx cancers and age-period-cohort effects in the Brazilian population of 30 years of age and over, in the period of 1990 to 2019.

METHODS: A time series study of the incidence and mortality rates for oral cavity and pharynx cancer (“Lip and oral cavity cancer”, “Nasopharynx cancer”, and “Other pharynx cancer”) was conducted, with corrected data from the Global Burden of Disease Study (GBD) 2019. Age-standardized rates per 100,000 inhabitants, for the global population, were gathered according to the individuals’ sex. The annual average percentage change (AAPC) was estimated, as was the age-period-cohort effects.

RESULTS: The incidence and mortality rates were higher for men in the studied anatomical regions. The cancers tended to decrease for men, except for nasopharynx cancer, which increased in individuals of both sexes. Mortality tended to present a decline in most of the groups studied. For men and women, the age-period-cohort model presented a better adjustment for both incidence and mortality.

CONCLUSIONS: Incidence and mortality caused by the main head and neck cancers showed a tendency to decline over the past 30 years in Brazil, except for nasopharynx cancer, which showed an increase in incidence and mortality in some segments of the population. Higher rates were found for lip and oral cavity cancers in men.

Keywords: Head and neck câncer; Epidemiology; Incidence; Mortality; Cohort effect; Global Burden of Disease

Characterists		Incidence - Male				Incidence - Female
		Lip and oral cavity cancer	Nasopharynx cancer	Other pharynx cancer	Head and Neck cancer	Lip and oral cavity cancer	Nasopharynx cancer	Other pharynx cancer	Head and Neck cancer
		Rate (95%CI)	Rate (95%CI)	Rate (95%CI)	Rate (95%CI)	Rate (95%CI)	Rate (95%CI)	Rate (95%CI)	Rate (95%CI)
Age group	30	1.28 (1.23;1.33)	0.15 (0.13;0.17)	0.43 (0.40;0.45)	1.96 (1.91;2.02)	0.48 (0.45;0.51)	0.07 (0.06;0.09)	0.11 (0.10;0.13)	0.64 (0.60;0.68)
	35	2.68 (2.60;2.76)	0.28 (0.25;0.31)	1.02 (0.98;1.06)	4.07 (3.98;4.16)	0.79 (0.74;0.83)	0.11 (0.10;0.13)	0.21 (0.19;0.23)	1.10 (1.05;1.15)
	40	5.60 (5.48;5.72)	0.51 (0.46;0.55)	2.42 (2.35;2.50)	8.43 (8.29;8.58)	1.29 (1.24;1.35)	0.18 (0.16;0.20)	0.40 (0.37;0.43)	1.89 (1.82;1.96)
	45	11.33 (11.12;11.55)	0.92 (0.85;1.00)	5.77 (5.63;5.91)	17.49 (17.24;17.74)	2.12 (2.05;2.20)	0.27 (0.24;0.31)	0.75 (0.70;0.80)	3.21 (3.11;3.32)
	50	19.04 (18.72;19.37)	1.53 (1.42;1.64)	11.95 (11.67;12.23)	32.74 (32.29;33.19)	3.43 (3.32;3.55)	0.38 (0.34;0.42)	1.34 (1.26;1.42)	5.15 (5.00;5.30)
	55	24.03 (23.64;24.43)	1.54 (1.45;1.63)	14.61 (14.28;14.96)	40.70 (40.18;41.23)	5.10 (4.95;5.25)	0.47 (0.42;0.52)	1.82 (1.72;1.92)	7.30 (7.11;7.49)
	60	27.59 (27.18;28.01)	1.39 (1.31;1.48)	17.08 (16.75;17.42)	45.48 (44.94;46.02)	6.64 (6.45;6.83)	0.50 (0.45;0.54)	2.10 (1.98;2.22)	9.09 (8.85;9.33)
	65	30.09 (29.60;30.59)	1.29 (1.20;1.38)	17.38 (17.01;17.76)	48.73 (48.10;49.36)	8.52 (8.26;8.79)	0.52 (0.46;0.57)	2.39 (2.27;2.53)	11.59 (11.30;11.89)
	70	30.95 (30.40;31.50)	1.20 (1.11;1.30)	15.77 (15.41;16.14)	48.54 (47.86;49.23)	11.84 (11.44;12.24)	0.54 (0.48;0.61)	2.77 (2.59;2.95)	15.09 (14.65;15.55)
	75	30.78 (30.14;31.42)	1.12 (1.01;1.24)	14.04 (13.63;14.46)	46.27 (45.51;47.05)	15.71 (15.15;16.30)	0.57 (0.50;0.66)	3.20 (2.98;3.42)	19.22 (18.62;19.84)
	80	30.44 (29.59;31.30)	1.05 (0.91;1.20)	12.49 (12.02;12.99)	43.79 (42.80;44.81)	19.92 (19.08;20.80)	0.61 (0.51;0.73)	3.68 (3.39;4.01)	24.05 (23.15;24.99)
		RR (95%CI)	RR (95%CI)	RR (95%CI)	RR (95%CI)	RR (95%CI)	RR (95%CI)	RR (95%CI)	RR (95%CI)
Cohort	1910	1.01 (0.97;1.05)	0.89 (0.73;1.09)	1.00 (0.95;1.06)	1.00 (0.97;1.03)	0.97 (0.92;1.02)	0.92 (0.70;1.20)	1.07 (0.96;1.19)	0.98 (0.94;1.03)
	1915	1.01 (0.98;1.04)	0.91 (0.77;1.07)	1.00 (0.96;1.05)	1.00 (0.98;1.03)	0.97 (0.93;1.01)	0.93 (0.75;1.16)	1.06 (0.97;1.16)	0.98 (0.95;1.02)
	1920	1.01 (0.99;1.04)	0.92 (0.80;1.06)	1.00 (0.97;1.04)	1.01 (0.99;1.03)	0.97 (0.93;1.00)	0.94 (0.79;1.13)	1.06 (0.99;1.14)	0.99 (0.96;1.02)
	1925	1.02 (1.00;1.04)	0.94 (0.84;1.04)	1.00 (0.98;1.03)	1.01 (0.99;1.03)	0.97 (0.94;1.00)	0.96 (0.84;1.10)	1.06 (0.99;1.13)	0.99 (0.96;1.02)
	1930	1.02 (1.00;1.04)	0.95 (0.88;1.03)	1.00 (0.98;1.03)	1.01 (1.00;1.02)	0.97 (0.94;1.00)	0.97 (0.88;1.08)	1.06 (0.99;1.12)	0.99 (0.97;1.02)
	1935	1.02 (1.01;1.04)	0.97 (0.93;1.01)	1.01 (0.99;1.02)	1.01 (1.00;1.02)	0.98 (0.95;1.00)	0.99 (0.91;1.07)	1.04 (0.99;1.10)	1.00 (0.97;1.02)
	1940	1.02 (1.01;1.03)	0.99 (0.96;1.01)	1.00 (0.99;1.02)	1.01 (1.00;1.02)	0.99 (0.98;1.01)	1.00 (0.94;1.06)	1.02 (0.99;1.04)	1.00 (0.99;1.01)
	1945	Reference	Reference	Reference	Reference	Reference	Reference	Reference	Reference
	1950	1.00 (1.00;1.01)	1.01 (0.97;1.05)	1.02 (1.01;1.03)	1.01 (1.01;1.02)	1.00 (0.98;1.02)	1.01 (0.96;1.06)	1.01 (0.98;1.03)	1.00 (0.99;1.02)
	1955	1.03 (1.02;1.05)	1.03 (0.9;1.09)	1.06 (1.04;1.08)	1.05 (1.04;1.06)	1.00 (0.98;1.03)	1.03 (0.95;1.11)	1.02 (0.97;1.08)	1.01 (0.98;1.04)
	1960	1.00 (0.98;1.02)	1.05 (0.98;1.12)	1.04 (1.02;1.07)	1.02 (1.00;1.03)	1.01 (0.98;1.04)	1.07 (0.95;1.20)	1.01 (0.95;1.08)	1.02 (0.98;1.05)
	1965	0.92 (0.90;0.94)	1.07 (0.99;1.15)	0.97 (0.95;1.00)	0.94 (0.93;0.96)	1.01 (0.98;1.05)	1.13 (0.99;1.28)	0.99 (0.93;1.06)	1.02 (0.99;1.06)
	1970	0.84 (0.82;0.86)	1.09 (1.00;1.18)	0.90 (0.87;0.93)	0.87 (0.85;0.88)	1.02 (0.97;1.07)	1.20 (1.04;1.38)	0.97 (0.89;1.06)	1.03 (0.99;1.07)
	1975	0.76 (0.74;0.79)	1.11 (0.99;1.23)	0.83 (0.79;0.87)	0.80 (0.78;0.82)	1.03 (0.97;1.09)	1.27 (1.07;1.51)	0.95 (0.85;1.06)	1.03 (0.98;1.08)
	1980	0.69 (0.67;0.72)	1.13 (0.98;1.30)	0.77 (0.72;0.81)	0.73 (0.71;0.76)	1.03 (0.96;1.11)	1.35 (1.10;1.67)	0.93 (0.81;1.06)	1.04 (0.98;1.10)
	1985	0.63 (0.60;0.66)	1.15 (0.96;1.37)	0.71 (0.66;0.76)	0.67 (0.65;0.70)	1.04 (0.95;1.13)	1.44 (1.12;1.86)	0.91 (0.77;1.07)	1.04 (0.97;1.12)
Period	1990	0.93 (0.92;0.95)	0.82 (0.77;0.87)	0.91 (0.89;0.93)	0.92 (0.91;0.93)	0.91 (0.89;0.93)	0.82 (0.75;0.90)	0.94 (0.90;0.99)	0.91 (0.89;0.93)
	1995	0.99 (0.98;1.01)	0.95 (0.90;1.01)	0.98 (0.96;1.00)	0.99 (0.98;1.00)	0.96 (0.93;0.98)	0.94 (0.86;1.03)	0.96 (0.91;1.01)	0.96 (0.94;0.98)
	2000	1.02 (1.01;1.04)	1.06 (0.99;1.12)	1.02 (1.01;1.04)	1.02 (1.01;1.03)	1.00 (0.97;1.02)	1.04 (0.94;1.15)	0.98 (0.94;1.03)	1.00 (0.97;1.02)
	2005	Reference	Reference	Reference	Reference	Reference	Reference	Reference	Reference
	2010	0.97 (0.95;0.98)	0.92 (0.86;0.98)	0.95 (0.93;0.97)	0.96 (0.95;0.97)	0.97 (0.94;1.00)	0.93 (0.84;1.03)	0.97 (0.92;1.02)	0.97 (0.95;0.99)
	2015	0.95 (0.94;0.97)	0.84 (0.79;0.90)	0.93 (0.91;0.95)	0.94 (0.93;0.95)	0.90 (0.88;0.93)	0.83 (0.75;0.92)	0.93 (0.89;0.98)	0.91 (0.88;0.93)

Characterists		Mortality - Male				Mortality - Female
		Lip and oral cavity cancer	Nasopharynx cancer	Other pharynx cancer	Head and Neck cancer	Lip and oral cavity cancer	Nasopharynx cancer	Other pharynx cancer	Head and Neck cancer
		Rate (95%CI)	Rate (95%CI)	Rate (95%CI)	Rate (95%CI)	Rate (95%CI)	Rate (95%CI)	Rate (95%CI)	Rate (95%CI)
Age group	30	0.66 (0.63;0.70)	0.12 (0.11;0.14)	0.38 (0.36;0.41)	1.16 (1.11;1.20)	0.20 (0.18;0.22)	0.05 (0.04;0.07)	0.10 (0.08;0.11)	0.35 (0.32;0.37)
	35	1.35 (1.30;1.41)	0.23 (0.21;0.26)	0.88 (0.84;0.92)	2.46 (2.39;2.53)	0.34 (0.31;0.37)	0.09 (0.07;0.11)	0.17 (0.15;0.19)	0.59 (0.56;0.63)
	40	2.77 (2.69;2.86)	0.43 (0.40;0.47)	2.01 (1.94;2.08)	5.22 (5.10;5.33)	0.58 (0.54;0.61)	0.14 (0.12;0.17)	0.31 (0.28;0.34)	1.02 (0.98;1.07)
	45	5.67 (5.53;5.81)	0.80 (0.74;0.87)	4.61 (4.48;4.74)	11.08 (10.88;11.29)	0.98 (0.93;1.02)	0.23 (0.20;0.26)	0.55 (0.52;0.60)	1.76 (1.70;1.83)
	50	10.75 (10.50;11.01)	1.31 (1.22;1.40)	9.58 (9.33;9.84)	21.61 (21.24;21.99)	1.64 (1.58;1.71)	0.32 (0.28;0.36)	0.97 (0.91;1.03)	2.98 (2.89;3.08)
	55	14.50 (14.20;14.82)	1.58 (1.48;1.70)	12.93 (12.63;13.25)	28.87 (28.42;29.33)	2.62 (2.53;2.72)	0.39 (0.34;0.44)	1.46 (1.38;1.54)	4.55 (4.42;4.69)
	60	15.90 (15.55;16.26)	1.23 (1.15;1.31)	13.87 (13.53;14.22)	31.05 (30.55;31.56)	3.79 (3.67;3.92)	0.44 (0.40;0.49)	1.73 (1.63;1.83)	5.90 (5.73;6.06)
	65	17.43 (17.04;17.82)	1.11 (1.03;1.19)	15.25 (14.87;15.63)	33.79 (33.24;34.34)	4.88 (4.70;5.07)	0.49 (0.44;0.56)	1.90 (1.78;2.02)	7.15 (6.92;7.38)
	70	19.65 (19.17;20.14)	1.19 (1.10;1.28)	15.39 (14.97;15.82)	36.33 (35.68;37.00)	6.35 (6.08;6.63)	0.55 (0.48;0.62)	2.30 (2.15;2.46)	9.19 (8.88;9.50)
	75	22.47 (21.88;23.08)	1.31 (1.18;1.45)	14.46 (14.02;14.91)	38.42 (37.67;39.20)	9.69 (9.20;10.20)	0.61 (0.53;0.70)	2.99 (2.78;3.21)	13.42 (12.90;13.96)
	80	25.76 (24.89;26.66)	1.44 (1.27;1.65)	13.42 (12.88;14.00)	40.52 (39.48;41.59)	18.13 (17.22;19.08)	0.67 (0.56;0.81)	4.00 (3.68;4.36)	22.61 (21.68;23.58)
		RR (95%CI)	RR (95%CI)	RR (95%CI)	RR (95%CI)	RR (95%CI)	RR (95%CI)	RR (95%CI)	RR (95%CI)
Cohort	1910	1.10 (1.05;1.15)	0.87 (0.71;1.06)	1.12 (1.06;1.19)	1.10 (1.07;1.14)	1.10 (1.03;1.18)	1.01 (0.78;1.31)	1.23 (1.11;1.37)	1.12 (1.06;1.18)
	1915	1.10 (1.06;1.14)	0.89 (0.75;1.05)	1.11 (1.06;1.16)	1.10 (1.07;1.13)	1.08 (1.03;1.14)	1.02 (0.82;1.26)	1.21 (1.11;1.32)	1.11 (1.06;1.16)
	1920	1.09 (1.06;1.12)	0.92 (0.80;1.05)	1.10 (1.06;1.14)	1.09 (1.06;1.11)	1.07 (1.02;1.11)	1.02 (0.86;1.21)	1.19 (1.11;1.28)	1.10 (1.06;1.14)
	1925	1.09 (1.06;1.12)	0.94 (0.85;1.04)	1.08 (1.05;1.12)	1.08 (1.06;1.10)	1.05 (1.00;1.10)	1.02 (0.89;1.17)	1.17 (1.09;1.25)	1.08 (1.04;1.12)
	1930	1.08 (1.05;1.11)	0.97 (0.90;1.04)	1.07 (1.05;1.10)	1.07 (1.05;1.09)	1.04 (1.00;1.08)	1.03 (0.92;1.15)	1.15 (1.07;1.23)	1.07 (1.03;1.10)
	1935	1.06 (1.04;1.08)	0.99 (0.95;1.04)	1.06 (1.03;1.08)	1.06 (1.04;1.07)	1.03 (1.00;1.07)	1.03 (0.93;1.13)	1.10 (1.05;1.16)	1.05 (1.02;1.07)
	1940	1.02 (1.01;1.03)	1.01 (0.98;1.04)	1.03 (1.01;1.05)	1.03 (1.02;1.04)	1.02 (1.00;1.04)	1.02 (0.95;1.09)	1.04 (1.01;1.07)	1.02 (1.01;1.04)
	1945	Reference	Reference	Reference	Reference	Reference	Reference	Reference	Reference
	1950	1.02 (1.01;1.03)	0.97 (0.93;1.02)	1.02 (1.01;1.03)	1.01 (1.01;1.02)	0.97 (0.96;0.99)	0.99 (0.94;1.03)	0.97 (0.94;1.01)	0.97 (0.95;0.99)
	1955	1.01 (0.99;1.04)	0.97 (0.92;1.03)	1.03 (1.01;1.05)	1.02 (1.01;1.04)	0.94 (0.92;0.96)	0.99 (0.90;1.08)	0.92 (0.88;0.97)	0.94 (0.91;0.96)
	1960	0.95 (0.92;0.97)	0.97 (0.91;1.04)	0.97 (0.94;1.00)	0.96 (0.94;0.98)	0.91 (0.87;0.94)	0.98 (0.86;1.12)	0.86 (0.81;0.92)	0.90 (0.87;0.93)
	1965	0.84 (0.82;0.87)	0.95 (0.88;1.03)	0.87 (0.85;0.90)	0.87 (0.85;0.88)	0.88 (0.83;0.93)	0.97 (0.84;1.11)	0.81 (0.75;0.87)	0.86 (0.83;0.90)
	1970	0.75 (0.72;0.77)	0.91 (0.83;1.00)	0.78 (0.75;0.81)	0.78 (0.76;0.79)	0.85 (0.79;0.91)	0.95 (0.81;1.12)	0.75 (0.68;0.83)	0.83 (0.78;0.87)
	1975	0.66 (0.64;0.69)	0.88 (0.78;0.99)	0.70 (0.66;0.73)	0.69 (0.67;0.72)	0.82 (0.75;0.89)	0.93 (0.77;1.14)	0.70 (0.62;0.80)	0.79 (0.74;0.85)
	1980	0.59 (0.56;0.62)	0.84 (0.72;0.98)	0.62 (0.58;0.66)	0.62 (0.60;0.65)	0.79 (0.71;0.88)	0.92 (0.72;1.17)	0.66 (0.56;0.77)	0.76 (0.70;0.83)
	1985	0.52 (0.49;0.56)	0.81 (0.66;0.98)	0.56 (0.51;0.60)	0.56 (0.53;0.58)	0.76 (0.67;0.86)	0.90 (0.67;1.22)	0.61 (0.51;0.74)	0.73 (0.66;0.81)
Period	1990	0.94 (0.93;0.96)	0.83 (0.78;0.88)	0.92 (0.90;0.94)	0.93 (0.91;0.94)	0.94 (0.91;0.97)	0.84 (0.76;0.92)	0.97 (0.92;1.02)	0.94 (0.91;0.96)
	1995	0.99 (0.97;1.01)	0.96 (0.90;1.02)	0.99 (0.97;1.01)	0.99 (0.97;1.00)	0.97 (0.93;1.00)	0.95 (0.86;1.05)	0.97 (0.92;1.02)	0.97 (0.94;1.00)
	2000	1.02 (1.00;1.04)	1.06 (1.00;1.14)	1.03 (1.01;1.05)	1.02 (1.01;1.03)	0.99 (0.96;1.02)	1.04 (0.94;1.16)	0.98 (0.93;1.03)	0.99 (0.97;1.02)
	2005	Reference	Reference	Reference	Reference	Reference	Reference	Reference	Reference
	2010	0.97 (0.95;0.99)	0.93 (0.86;0.99)	0.95 (0.93;0.97)	0.96 (0.95;0.97)	0.98 (0.95;1.01)	0.94 (0.84;1.05)	0.98 (0.92;1.04)	0.98 (0.95;1.01)
	2015	0.96 (0.94;0.98)	0.86 (0.80;0.92)	0.94 (0.92;0.96)	0.95 (0.93;0.96)	0.93 (0.89;0.96)	0.85 (0.76;0.95)	0.96 (0.91;1.01)	0.93 (0.91;0.96)

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[TFN1] RR: Relative Risk; CI: Confidence Interval.