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PLoS One. 2019 Jan 25;14(1):e0210980. doi: 10.1371/journal.pone.0210980. eCollection 2019.

Different spatial pattern of municipal prostate cancer mortality in younger men in Spain.

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Urology Department, Fuenlabrada General Hospital, Fuenlabrada, Spain.
Rey Juan Carlos University, Móstoles, Spain.
Cancer & Environmental Epidemiology Unit, Department of Epidemiology of Chronic Diseases, National Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain.
Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), Madrid, Spain.
Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain.
Complejo Hospitales Universitarios, Granada, Spain.
Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain.
Cardiovascular & Metabolic Diseases Unit, Department of Epidemiology of Chronic Diseases, National Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain.



Prostate cancer (PC) primarily affects elderly men. However, the specific features of cases diagnosed at younger ages (<65 years) suggest that they may represent a different clinical subtype. Our aim was to assess this suggestion by contrasting the geographical PC mortality and hospital admissions patterns in Spain for all ages to those in younger men.


The Spanish National Institute of Statistics supplied data on PC mortality, hospital admission, and population data. We estimated the expected town-specific number of deaths and calculated the standardized mortality ratios. Spatial autoregressive models of Besag-York-Mollié provided smoother municipal estimators of PC mortality risk (all ages; <65 years). We computed the provincial age-standardized rate ratios of PC hospital admissions (all men; <60 years) using Spanish rates as the reference.


A total of 29,566 PC deaths (6% among those <65 years) were registered between 2010-2014, with three high-mortality risk zones: Northwest Spain; Southwest Andalusia & Granada; and a broad band extending from the Pyrenees Mountains to the north of Valencia. In younger men, the spatial patterns shared the high risk of mortality in the Northwest but not the central band. The PC hospital discharge rates confirmed a North-South gradient but also low mortality/high admission rates in Madrid and Barcelona and the opposite in Southwest Andalusia.


The consistent high PC mortality/morbidity risk in the Northwest of Spain indicates an area with a real excess of risk. The different spatial pattern in younger men suggests that some factors associated with geographical risk might have differential effects by age. Finally, the regional divergences in mortality and morbidity hint at clinical variability as a source of inequity within Spain.

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