Research Article| Volume 163, ISSUE 2, P127-136, March 01, 1999

Download started.


Malignant brain tumour mortality among children and adolescents: geographical distribution in Spain


      Log-linear Poisson mixed models were used to study provincial malignant brain tumour (MBT) mortality among children and adolescents in Spain (1975–1992) in order to investigate the influence of specific socio-economic factors and to produce smoothed estimators of standardised mortality ratios (SMRs). Interdependence between geographical units was taken into account by including provinces as random effect terms nested with the corresponding Autonomous Region (Spain’s administrative divisions). MBT mortality showed a positive association with three variables: non-cancer-related infant mortality; percentage of provincial land surface area devoted to agriculture; and industrial/construction activity. According to the final model, SMRs increased by 4% with every 10% rise in the area devoted to agriculture, with a 4% excess risk predicted for every increase in non-cancer-related infant mortality of 1 per 1000 person-years, and a 7% excess risk for contiguous categories of industrial/construction activity. By smoothing extreme values caused by random variability, the regression model yielded a reasonable estimation of SMRs. While infant mortality may be linked to the quality of medical care available, the relationship seen between MBT mortality and agricultural area accords with the excess risk reported for farmers’ offspring. Finally, industrial activity might be regarded as a risk factor or as a marker of other conditions also associated with these tumours.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the Neurological Sciences
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Stiller C.A.
        • Nectoux J.
        International incidence of childhood brain and spinal tumours.
        Int J Epidemiol. 1994; 23: 458-464
        • Pollack I.F.
        Brain tumors in children.
        New Engl J Med. 1994; 331: 1500-1507
        • Lannering B.
        • Marky Y.
        • Nordborg C.
        Brain tumours in childhood and adolescence in west Sweden 1970–1984: epidemiology and survival.
        Cancer. 1990; 66: 604-609
        • Blair V.
        • Birch J.M.
        Patterns and temporal trends in the incidence of malignant disease in children: II. Solid tumours of childhood.
        Eur J Cancer. 1994; 30: 1498-1511
        • Pollán M.
        • López-Abente G.
        • Ardanaz E.
        • Moreo P.
        • Moreno C.
        • Vergara A.
        • Aragonés N.
        Childhood cancer incidence in Zaragoza and Navarre (Spain): 1973–1987.
        Eur J Cancer. 1997; 33: 616-623
        • Martos M.C.
        • Olsen J.H.
        Childhood cancer mortality in the European Community, 1950–1989.
        Eur J Cancer. 1993; 12: 1783-1789
        • Breslow N.E.
        • Langholz B.
        Childhood cancer incidence: geographical and temporal variations.
        Int J Cancer. 1983; 32: 703-716
        • Parkin M.
        • Nectoux J.
        • Stiller C.
        • Draper G.
        L’Incidence des cancers de l’enfant dans le monde.
        Pediatrie. 1989; 44: 725-736
        • Levi F.
        • La Vecchia C.
        • Lucchini F.
        • Negri E.
        • Boyle P.
        Patterns of childhood cancer incidence and mortality in Europe.
        Eur J Cancer. 1992; 28: 2028-2039
        • Pollán M.
        • López-Abente G.
        • Ruiz-Tovar M.
        • Martı́nez de Aragón M.V.
        Childhood and adolescent cancer in Spain: mortality time trends 1956–1990.
        Eur J Cancer. 1995; 31: 1811-1821
        • Aickin M.
        • Dunn C.N.
        • Flood T.J.
        Estimation of population denominators for public health studies at the tract, gender and age-specific level.
        Am J Public Health. 1991; 81: 918-920
        • Breslow N.E.
        • Day N.E.
        Statistical methods in cancer research. The analysis of cohort studies. II. IARC Scientific Publications, Lyon1987
        • Smans M.
        • Esteve J.
        Practical approaches to disease mapping.
        in: Elliott P. Cuzick J. Stern R. Geographical and environmental epidemiology: methods for small area studies. Oxford University Press, Oxford1992: 141-150
        • López-Abente G.
        • Pollán M.
        • Escolar A.
        • Errezola M.
        • Abraira V.
        Atlas of cancer mortality and other causes of death in Spain, 1978–1992. Fundación Cientı́fica de la Asociación Española Contra el Cáncer, Madrid1996
        • Wolfinger R.
        • O’Connell M.
        Generalized linear mixed models: a pseudo-likelihood approach.
        J Statist Comput Simul. 1993; 48: 233-243
      1. Instituto Nacional de Estadı́stica. Anuario estadı́stico español 1990. Madrid: I.N.E, 1991.

      2. PRISA Group. El Paı́s. Anuario 1996. Madrid: El Paı́s, 1996.

      3. Banco Español de Crédito. Anuario del mercado Español, 1991. Madrid: Banco Español de Crédito, 1991.

      4. Registro Nacional de Tumores Infantiles. Estadı́sticas básicas 3 (1980–1990: Supervivencia 1980–1989). Valencia: Generalitat Valenciana, 1992.

        • Berrino F.
        • Sant M.
        • Verdecchia A.
        • Capocaccia R.
        • Hakulinen T.
        • Estève J.
        Survival of cancer patients in Europe. the Eurocare Study. IARC Scientific Publications, Lyon1995
      5. Ministerio de Sanidad y Consumo. Cáncer en España. Madrid: Ministerio de Sanidad y Consumo, 1993.

        • Clayton D.G.
        • Bernardinelli L.
        • Montomoli C.
        Spatial correlation in ecological analysis.
        Int J Epidemiol. 1993; 22: 1193-1202
        • Clayton D.G.
        • Kaldor J.
        Empirical Bayes estimates of age-standardised relative risk for use in disease mapping.
        Biometrics. 1987; 43: 671-681
        • Eaton N.
        • Shaddick G.
        • Dolk H.
        • Elliot P.
        Small-area study of the incidence of neoplasms of the brain and central nervous system among adults in the West Midlands Region, 1974–1986.
        Br J Cancer. 1997; 75: 1080-1083
        • Spiegelhalter D.
        • Thomas A.
        • Best N.
        • Gilks W.
        BUGS. Bayesian inference using Gibbs sampling. Version 0.50. MRC Biostatistics, Cambridge1995
        • Greenland S.
        • Robins J.
        Invited commentary: ecologic studies—biases, misconceptions, and counterexamples.
        Am J Epidemiol. 1994; 139: 747-760
        • Schwartz S.
        The fallacy of the ecological fallacy: the potential misuse of a concept and the consequences.
        Am J Public Health. 1994; 84: 819-824
        • Richardson S.
        Statistical methods for geographical correlation studies.
        in: Elliott P. Cuzick J. Stern R. Geographical and environmental epidemiology: methods for small area studies. Oxford University Press, Oxford1992: 181-204
        • Kuijten R.R.
        • Bunin G.R.
        Risk factors for childhood brain tumors.
        Cancer Epidemiol Biomarkers Prev. 1993; 2: 277-288
        • Wilkins J.R.
        • Koutras R.A.
        Paternal occupation and brain cancer in offspring: a mortality-based case-control study.
        Am J Ind Med. 1988; 14: 299-318
        • Wilkins J.R.
        • Sinks T.H.
        Parental occupation and intracranial neoplasms of childhood: results of a case-control interview study.
        Am J Epidemiol. 1990; 132: 275-292
        • Gold E.
        • Gordis L.
        • Tonascia J.
        • Szklo M.
        Risk factors for brain tumors in children.
        Am J Epidemiol. 1979; 109: 309-319
        • Musicco M.
        • Sant M.
        • Molinari S.
        • Filippini G.
        • Gatta G.
        • Berrino F.
        A case-control study of brain gliomas and occupational exposure to chemical carcinogens: the risk of farmers.
        Am J Epidemiol. 1988; 128: 778-785
        • Brownson R.C.
        • Reif J.S.
        • Chang J.C.
        • Davis J.R.
        An analysis of occupational risks for brain cancer.
        Am J Public Health. 1990; 80: 169-172
        • López-Abente G.
        Cáncer en agricultores. Mortalidad proporcional y estudios caso-control con certificados de defunción. Fondo de Investigación Sanitaria, Madrid1991
        • Rodvall Y.
        Epidemiological studies on tumours of the central nervous system and childhood cancer. Karolinska Institute, Stockholm1996
      6. Ministerio de Obras Públicas y Transportes. Atlas nacional de España. Información demográfica. Madrid: Ministerio de Obras Públicas y Transportes, 1992.

        • Knox E.G.
        • Gilman E.A.
        Hazard proximities of childhood cancers in Great Britain from 1953–80.
        J Epidemiol Community Health. 1997; 51: 151-159
      7. Centers for Disease Control. Consensus set of health status indicators for the general assessment of community health status—United States. MMWR 1991;40:449–51.

        • Vázquez-Vizoso F.
        • Castilla J.
        • Pollán M.
        • López-Abente G.
        Assessment of trends in geographical inequalities in infant mortality.
        Social Sci Med. 1993; 37: 413-417
        • McKinney P.A.
        • Ironside J.W.
        • Harkner E.F.
        • Arango J.C.
        • Doyle D.
        • Black R.J.
        Quality and descriptive epidemiology of childhood brain tumours in Scotland 1975–1990.
        Br J Cancer. 1994; 70: 973-979