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PubMedDate not supplied

[Geographical distribution and time trends of suicide mortality in Catalonia and Spain [1986-2002]].

OBJECTIVE: To analyze time trends in Catalonia (1986-2002) and Spain (1986-2001) in suicide mortality and its geographical variation by health areas in Catalonia. METHODS: Standard annual mortality rates were calculated by the direct method for Catalonia (1986-2002) and Spain (1986-2001) (standard population of Catalonia 1991). The adjusted annual percent change was analyzed by means of a Poisson regression by gender and by age group for Catalonia and Spain. For the geographical variation in Catalonia, standardized mortality ratio using the indirect method (SMR) were calculated by gender and for the 46 health areas for the entire period and the comparative mortality figures and its confidence intervals at 95% were analyzed grouping the years in period 1(1986-1994) and period 2 (1995-2002). RESULTS: Men's mortality in Catalonia was lower than in Spain and an increase (not significant) was observed in both places during the period; for women, the evolution and rates were similar, with a small decrease (significant) for Catalonia and Spain. Differences in patterns and trends for age and sex were observed, showing a decrease in the elderly groups for both sexes and an increase for the young for Spain and Catalonia. In terms of geographic distribution, the health sectors of the Central, Northeast and South Catalonia zones show higher than average mortality. CONCLUSIONS: The time trends of mortality by suicide in Catalonia shows different patterns according to age and gender. A progressive homogenization in the territorial distribution by health areas was observed.

Adolescent↗

PubMedDate not supplied

Time trends analysis of hearing loss: an alternative approach to evaluating hearing loss prevention programs.

Two general approaches for evaluating the performance of hearing loss prevention programs (HLPPs) are described in the literature: (1) a comparison of the rate of hearing loss in an HLPP with a reference population and (2) a comparison of audiometric variability or annual incidence of hearing loss with an established set of criteria that rank HLPP performance on a graded scale. This article discusses a third method, time trends analysis, which assesses patterns in hearing loss over time. Patterns may reflect program improvement (decreased hearing loss incidence over time), deterioration (a pattern of increased incidence), or stasis (unchanged incidence). To demonstrate this method, a time trends analysis was conducted on a population of 44,547 industrial workers. Subjects were divided into 11 subgroups based on year of enrollment in the HLPP (1980-1990) and followed retrospectively for 3 years to determine the incidence of hearing loss. Hazard ratios (HRs) were estimated for each subgroup by gender using the Cox Proportional Hazards model and adjusting for age, race, and hearing threshold at enrollment in the HLPP. For women, plots of adjusted HRs against enrollment years produced a statistically significant (p < 0.05) quadratic trend of an initial increase in hearing loss, followed by decreasing incidence over time. For men, there was a statistically significant linear trend of decreasing hearing loss over time. The downward trend, particularly during the late 1980s, indicates improved HLPP performance during the latter portion of the decade. Time trends analysis can be a valuable tool for assessing HLPP performance for those with access to follow-up data and ability to work with statistical models.

Adult↗

PubMed1997

Modeling of time trends and interactions in vital rates using restricted regression splines.

For the analysis of time trends in incidence and mortality rates, the age-period-cohort (apc) model has became a widely accepted method. The considered data are arranged in a two-way table by age group and calendar period, which are mostly subdivided into 5- or 10-year intervals. The disadvantage of this approach is the loss of information by data aggregation and the problems of estimating interactions in the two-way layout without replications. In this article we show how splines can be useful when yearly data, i.e., 1-year age groups and 1-year periods, are given. The estimated spline curves are still smooth and represent yearly changes in the time trends. Further, it is straightforward to include interaction terms by the tensor product of the spline functions. If the data are given in a nonrectangular table, e.g., 5-year age groups and 1-year periods, the period and cohort variables can be parameterized by splines, while the age variable is parameterized as fixed effect levels, which leads to a semiparametric apc model. An important methodological issue in developing the nonparametric and semiparametric models is stability of the estimated spline curve at the boundaries. Here cubic regression splines will be used, which are constrained to be linear in the tails. Another point of importance is the nonidentifiability problem due to the linear dependency of the three time variables. This will be handled by decomposing the basis of each spline by orthogonal projection into constant, linear, and nonlinear terms, as suggested by Holford (1983, Biometrics 39, 311-324) for the traditional apc model. The advantage of using splines for yearly data compared to the traditional approach for aggregated data is the more accurate curve estimation for the nonlinear trend changes and the simple way of modeling interactions between the time variables. The method will be demonstrated with hypothetical data as well as with cancer mortality data.

Age Factors↗

PubMed2004

Time trends of female lung cancer in Hong Kong: Age, period and birth cohort analysis.

The study was conducted to estimate the effects of age, year of diagnosis (period) and year of birth (cohort) on the time trend of female lung cancer incidence between 1976 and 2000 in Hong Kong. Data were obtained from a population-based cancer registry and the Census and Statistics Department. Using the Hong Kong general population of 1990 as the reference, age-adjusted incidence rates were computed by using direct standardization. We also analyzed secular trends in 2 consecutive periods, 1976-1990 and 1991-2000, using a Poisson regression model to estimate the annual percentage change in incidence rate. Age, period and cohort effects were assessed employing the method proposed by Clayton and Schifflers with 3 Poisson regression models fitted separately for age alone, age and period, and age and cohort. The age-adjusted incidence rate increased steadily up to 1990, when a peak of 40.1 per 100,000 was reached. Thereafter, a downward trend was observed. The overall annual increase was 4.2% during the period 1976-1990 with the fastest increase observed in women aged 80-84 years. An overall decrease of 2.3% was seen in the period 1991-2000, with the greatest reduction occurring in the 35-39 age group. After the adjustment for age, significant period and cohort effects on the time trend of incidence were observed. The age-cohort model provided a better description of the data than the age-period model. The risk of successive 5-year birth cohorts increased from 1896 to 1925 and then decreased. The time trend of lung cancer incidence of Hong Kong female in 1976-2000 had a marked birth cohort effect. Our results imply that major sources of exposure, which carry an increased risk of lung cancer for Hong Kong women, have been becoming less common in recent decades. Domestic air pollution, poor nutrition and tobacco smoking might have played important roles in the change of risks in successive generations and provide guidance for future interventions.

Adult↗

PubMed1996

Childhood leukaemias in New Zealand: time trends and ethnic differences.

Registrations from the New Zealand Cancer Registry were used to examine time trends in the incidence of leukaemias among children aged 0-14. There was a statistically significant increase in the incidence of leukaemia among children aged 0-4 during 1953-57 to 1988-90. In this age group, the recorded incidence rate increased from 4.89 per 100,000 person-years in 1953-57 to 7.92 in 1988-90. During 1973-77 to 1988-90 (and probably in earlier years), the increase was due to an increase in acute lymphoblastic leukaemia (ALL). The trends were unlikely to be due to changes in diagnosis or case ascertainment. The childhood leukaemia trends might be related to trends in family size, maternal age, socioeconomic level or exposure to infections. However, there are uncertainties about the importance of these factors or about their trends. The incidence of acute non-lymphoblastic leukaemia (ANLL) decreased between 1968-72 and 1988-90. The time trends highlight the likely importance of environmental factors in the aetiology of childhood leukaemias in New Zealand. The risk of ALL was lower in the Maori than in the non-Maori population (relative risk Maori/non-Maori 0.74). The risk of ANLL was higher among Maori (relative risk 1.84).

Adolescent↗

PubMed2005

Time trends in burdens of cadmium, lead, and mercury in the population of northern Sweden.

The time trends of exposure to heavy metals are not adequately known. This is a worldwide problem with regard to the basis for preventive actions and evaluation of their effects. This study addresses time trends for the three toxic elements cadmium (Cd), mercury (Hg), and lead (Pb). Concentrations in erythrocytes (Ery) were determined in a subsample of the population-based MONICA surveys from 1990, 1994, and 1999 in a total of 600 men and women aged 25-74 years. The study took place in the two northernmost counties in Sweden. To assess the effect of changes in the environment, adjustments were made for life-style factors that are determinants of exposure. Annual decreases of 5-6% were seen for Ery-Pb levels (adjusted for age and changes in alcohol intake) and Ery-Hg levels (adjusted for age and changes in fish intake). Ery-Cd levels (adjusted for age) showed a similar significant decrease in smoking men. It is concluded that for Pb and maybe also Hg the actions against pollution during recent decades have caused a rapid decrease of exposure; for Hg the decreased use of dental amalgam may also have had an influence. For Cd, the decline in Ery-Cd was seen only in smokers, indicating that Cd exposure from tobacco has decreased, while other environmental sources of Cd have not changed significantly. To further improve the health status in Sweden, it is important to decrease the pollution of Cd, and actions against smoking in the community are important.

Adult↗

PubMedDate not supplied

[Time trends in cancer incidence in Navarra and Zaragoza, spain].

BACKGROUND AND OBJECTIVES: The knowledge of time-related changes occurring in cancer incidence and mortality is an essential element for cancer control. This paper aims to describe the time trends of the more important cancer sites in Navarra and Zaragoza. METHODS: The influence of age, diagnosis period and birth cohort on the observed time trend cancer incidence in Navarre and Zaragoza was assessed using a log-linear model. Results are showed graphically, for the different tumour sites by sex and each registry. RESULTS: Among males, a considerable rise in the incidence of lung cancer (5% per year), prostate cancer (> 2% per year) and non-Hodgkin's lymphomas was found. Among females, the highest increases corresponded to non-Hodgkin's lymphomas, with a yearly rise greater than 7%, and ovarian cancer (4% per year). Breast cancer in women increased in both registries (3.5% per year in Navarre and 0.9% per year in Zaragoza), part of the increment in Navarra being explained by a higher case detection rate. Finally, the incidence of colorectal, bladder and kidney cancer rose more than a 3% per year in both registries and sexes. For most types of tumours, cancer risk increased with subsequent generations. CONCLUSION: The substantial cancer increment observed points out the inefficacy of primary prevention policies, the importance of studying cancer incidence for long time periods and the need to increase the population coverage of Spanish cancer registries.

Adult↗

PubMed1994

Time trend and the age-period-cohort effect on the incidence of histologic types of lung cancer in Connecticut, 1960-1989.

BACKGROUND: Recent epidemiologic studies have suggested changing patterns of lung cancer incidence by histologic type. The observed time trends have been attributed to a change in the rate of cigarette smoking, changes in exposure to new environmental carcinogens, and changes in the criteria for the histopathologic diagnosis of lung cancer. The current study was designed to examine the incidence patterns of lung cancer by histologic type in Connecticut and to use this information to project the future trend of the disease in this population. METHODS: This study was based on all the lung cancer cases reported to the Connecticut Tumor Registry between 1960 and 1989. On the basis of this data set, crude and age-adjusted incidence rates of lung cancer were calculated by histologic type for each sex. The age-specific incidence rates are presented by calendar year and cohort year of birth. A regression model was used to identify birth cohort, period, and age as determinants of the observed time trends. RESULTS: For the overall age-adjusted incidence rates, squamous cell carcinoma and small cell carcinoma have stabilized in men, whereas they are still increasing in women. The incidence of adenocarcinoma has been increasing in both men and women, but there has been a much sharper incidence among females since the mid-1970s. An examination of age-specific incidence rates by birth cohort and the results from age-period-cohort modeling indicate that incidences of all three major histologic types of lung cancer in the recent birth cohorts either have started decreasing (squamous cell carcinoma) or shown a clear reduction in the rate of increase (adenocarcinoma and small cell carcinoma). This study, however, did not indicate an increase of bronchoalveolar lung carcinoma, which was reported by other clinically based studies. CONCLUSION: While the overall age-adjusted incidence rates showed different incidence patterns for different histologic types of lung cancer, a decreasing or stabilized rate for all three major histologic types of lung cancer was observed in recent birth cohorts in both males and females. The observed incidence pattern is consistent with smoking trends over time including changes in smoking prevalence and the consumption of low tar and filter cigarettes. It is expected that if the current trend in tobacco smoking continues and if there are no major changes in other risk factors for lung cancer, a forthcoming stabilization or decrease in the rate of lung cancer incidence for all major histologic types (including adenocarcinoma) in both sexes in Connecticut could be anticipated.

Adenocarcinoma↗

PubMed1998

Opposing time trends of peptic ulcer and reflux disease.

BACKGROUND: Gastritis associated hypochlorhydria may be protective against gastro-oesophageal reflux disease. It was hypothesised that the historic decline in Helicobacter pylori infection resulted in a decline in peptic ulcer and a concomitant risk in reflux disease. AIMS: To study the time trends of peptic ulcer and reflux disease. METHODS: Hospitalisation rates were analysed using the computerised database of the US Department of Veterans Affairs from 1970 until 1995. Death rates were calculated from the Vital Statistics of the United States. RESULTS: From 1970 to 1995, hospitalisation rates for gastric and duodenal ulcer, as well as gastric cancer fell, while the hospitalisation rates for gastro-oesophageal reflux disease and those for oesophageal adenocarcinoma rose significantly. Similar time trends were observed with respect to the death rates. There were notable ethnic differences. White subjects incurred higher rates of reflux disease and oesophageal adenocarcinoma and lower rates of gastric ulcer or cancer compared with non-whites. CONCLUSIONS: The ethnic variations and the opposing time trends of gastroduodenal versus oesophageal disease are consistent with the hypothesis that the declining infection rates of H pylori in the general population have led to a rise in the occurrence of gastro-oesophageal reflux disease and associated oesophageal adenocarcinoma.

Adenocarcinoma↗

PubMed2004

[Time trends in prevalence of symptoms of allergic rhinitis in 13-14 year-old schoolchildren in 8 areas of Spain between 1993-1994 and 2001-2002 according to the International Study of Asthma and Allergies in Childhood (ISAAC)].

BACKGROUND AND OBJECTIVE: Our goal was to estimate the time trends in the prevalence of symptoms of allergic rhinitis (AR) and its geographic variations. POPULATION AND METHOD: During 2001-2002, the phase 3 of ISAAC study was carried out, and a comparison with the phase 1 (1993-1994) was done. This cross sectional study included 30,046 schoolchildren 13-14 years-old from 9 centers (Asturias, Barcelona, Bilbao, Cartagena, Castellon, Madrid, Pamplona, Valencia, and Valladolid). A questionnaire about rhinitis symptoms self-administered to schoolchildren was used at schools and institutes with a participation rate of 100% to 75.8%. RESULTS: A divergent time trend of AR prevalence symptoms was observed with a decrease in Barcelona and Bilbao, a stabilization in Cartagena, Pamplona, and Valencia, and an increase in Castellon; Madrid and Valladolid; however, there was an overall increase in nasal allergy. The prevalence of rhinoconjunctivitis in the past year (Prevalence Ratio [PR] = 1,13; 95% Confidence Interval [CI], 1.07-1.19) and nasal allergy ever (PR = 1.22; 95% CI, 1.15-1.30) increased after adjusting for gender, center and season change. The prevalence of rhinoconjunctivitis and nasal allergy varied according to centres, Madrid, Asturias, Cartagena and Bilbao exhibiting the higher prevalence. Taken as a whole, these data indicate a middle prevalence of AR when compared with other countries following an ISAAC methodology. CONCLUSIONS: Two patterns of time trend of prevalence of symptoms of AR were observed. The investigation of risk factors at local level could be important in order to undertake preventive measures.

Adolescent↗

PubMed2006

Small intestinal cancer in England & Wales and Scotland: time trends in incidence, mortality and survival.

BACKGROUND: Time trends in mortality from small intestinal cancer have not been studied for the 1990s. OBJECTIVE: To examine secular trends in incidence of, mortality from, and survival from, small intestinal cancer in England & Wales and Scotland from 1975 to 2002, considering also histological type (incidence), subsite (incidence) and indices of social deprivation (incidence and survival). METHODS: Data were extracted from the Scottish Cancer Registry database and the General Register Office for Scotland, and from the National Cancer Intelligence Centre at the Office for National Statistics for England & Wales. RESULTS: Incidence rates for small intestinal cancer increased for both England & Wales and Scotland over the study period. They were highest among older individuals and generally greater for males than for females. Despite the increase in incidence rates, mortality rates from small intestinal tumours tended to remain stable over the study period, and the general trend was towards increasing survival. Indices of social deprivation were not obviously related to the incidence of small intestinal cancer and did not influence survival. CONCLUSIONS: Incidence rates for small intestinal cancer for both England & Wales and Scotland increased in the last quarter of the 20th century, but survival rates improved and mortality rates declined.

Female↗

PubMed2005

Time trends in child and adolescent mental disorders.

PURPOSE OF REVIEW: 1995 saw the publication of a major review of time trends in psychosocial disorders of youth across the second half of the twentieth century. It found evidence for substantial increases in rates of youth crime, alcohol and drug use, depression and suicide in most industrialized countries in the decades following the Second World War, slowing in some instances in the 1980s. Ten years on, we review findings on more recent trends in rates of these and other indicators of child and adolescent mental health. RECENT FINDINGS: Prevalence estimates for autism spectrum disorders have increased in recent decades, as has public and professional awareness of hyperactivity and attention deficits. Trends in adolescent conduct problems, and in alcohol and drug use, appear to reflect culture-specific influences. Rates of suicide among young males, and self-harm among females have risen in many countries in recent years; trends in emotional disorders are more varied, but there is little evidence for any rise in rates of anorexia nervosa. Although some contributors to these trends have been identified, much remains to be learned about the key risks involved. SUMMARY: Monitoring time trends in child and adolescent mental health is essential for service planning; knowledge of changing trends can also provide important pointers to potential risk factors. Current data sources allow relatively reliable tracking of trends in some areas, but remain severely limited in others. Further research is needed to understand the mechanisms underlying recently identified trends in child and adolescent mental health.

Journal Article↗

PubMed2005

Time trends in the impact factor of Public Health journals.

BACKGROUND: Journal impact factor (IF) is linked to the probability of a paper being cited and is progressively becoming incorporated into researchers' curricula vitae. Furthermore, the decision as to which journal a given study should be submitted, may well be based on the trend in the journal's overall quality. This study sought to assess time trends in journal IF in the field of public, environmental and occupational health. METHODS: We used the IFs of 80 Public Health journals that were registered by the Science Citation Index from 1992 through 2003 and had been listed for a minimum period of the previous 3 years. Impact factor time trends were assessed using a linear regression model, in which the dependent variable was IF and the independent variable, the year. The slope of the model and its statistical significance were taken as the indicator of annual change. RESULTS: The IF range for the journals covered went from 0.18 to 5.2 in 2003. Although there was no statistical association between annual change and mean IF, most of the fastest growing journals registered mean IFs in excess of 1.5, and some represented emerging areas of public health research. Graphs displaying IF trends are shown. CONCLUSION: In view of the delay between the publication of IFs and that of any given paper, knowing the trend in IF is essential in order to make a correct choice of journal.

Bibliometrics↗

PubMed2003

Time trends and occupational risk factors for pleural mesothelioma in Sweden.

Epidemiologic data on pleural mesothelioma are scarce on regional and occupational time trends, which would monitor the effects of changes in exposure to asbestos. We aim to characterize time trends, regional, socioeconomic, and occupational risk factors for pleural mesothelioma in Sweden in the years from 1961 to 1998. The Swedish Family-Cancer Database was used to identify patients with pleural mesothelioma. Age-standardized incidence rates and standardized incidence ratio (SIR) were calculated for the population in the Database. A total of 1298 male and 233 female pleural mesotheliomas were retrieved. Age-standardized incidence of the disease was highest, and the trend increased in residents of large industrial and shipbuilding cities. In the last follow-up period, the male rate exceeded the female rate about 10-fold. Among male socioeconomic groups, manual workers showed the highest and ever-increasing SIR. No female socioeconomic group was at risk. For men, plumbers and seamen had the highest risk of 4.56 and 2.83, respectively, but the risks appeared to be decreasing for plumbers, whereas no clear trend was noted for seamen, probably because of indirect expose in ships. Farmers showed an SIR of 0.28, indicating that the population at large was at four times higher risk than farmers. The SIRs of many academic/college-educated groups were two to six times higher than those of farmers, suggesting indirect exposure to asbestos in these groups.

Adult↗

PubMed2000

Time trends in ovarian cancer mortality in Europe (1955-1993): effect of age, birth cohort and period of death.

The time trend in ovarian cancer mortality in the European Union over the period 1955-1993, and the age, period-of-death and birth cohort components underlying the trend's evolution were analysed using log-linear Poisson models to quantify risk of dying from ovarian cancer in the different countries and regions of Europe, and ascertain the relative annual trend for each country. Furthermore, age-period-cohort models were fitted for each country in order to ascertain the effect on time trend exerted by the respective age, period-of-death and birth cohort components. Ovarian cancer mortality proved 2.77-fold (95% confidence interval (CI) 2.60-2.95) higher in northern versus southern Europe over the period 1955-1993. Denmark registered the highest adjusted rates, namely, 14.3 per 100000 person-years for the 1989-1993 5-year period, the last studied, with Portugal (4.5 per 100000) and Greece (4.5 per 100000) being the countries with the lowest rates. Spain and Greece, with annual rises of 5.8% (95% CI 5.3-6.3) and 5.1% (95% CI 4.2-6.0) respectively, were the countries that displayed the greatest increase in ovarian cancer mortality. Risk of death associated with the birth cohort effect declined in all northern countries from 1920 to 1930. In the south, Italy and France recorded a decline in risk from 1930. Women in Spain and Greece registered an increase in birth cohort-associated mortality, which became less pronounced after 1930. Ovarian cancer mortality in Europe evinces a south-north distribution pattern. The mortality risk for women cohorts born in northern Europe witnessed a gradual decline from 1920 to 1930. In the southern region: (1) Italy and France display a cohort effect of decreased risk from 1930; and (2) Greece and Spain show a cohort effect of increased risk among the different generations of women, though this became less pronounced from 1930 onwards.

Adult↗

PubMed1998

Epidemiology and time trends of gestational trophoblastic disease in Korea.

OBJECTIVES: For the purpose of determining the annual incidence and time trends of gestational trophoblastic disease (GTD), the medical records from 24 university hospitals, 13 private general hospitals and the Korean Research Institute of Gestational Trophoblastic Disease (KRI-TRD) were analyzed from 1971 to 1995. MATERIALS & RESULTS: From a total of 7198 GTD cases (H-mole=3831, Invasive mole=2163, Choriocarcinoma=1177, PSTr=27) among 838659 deliveries between 1971 and 1995, the hospital-based incidence of H-mole per 1000 deliveries declined from 40.2 during 1971-975, to 2.3 during 1991-995. The population-based incidence of H-mole, however, revealed an average of 2.05 per 1000 deliveries during 1991-995. Old age and gravidities as factors in GTD patients both decreased significantly during the study period. Time trends for the incidence of GTD in Korea revealed significant changes, not only a decrease in the incidence of GTD, but also an improvement in the annual remission rate. Korea's socio-eonomic improvement in recent decades also contributed to the decreased incidence of GTD and the increased survival rates.

Choriocarcinoma↗

PubMed2005

Long-term all-sites cancer mortality time trends in Ohio, USA, 1970-2001: differences by race, gender and age.

BACKGROUND: There were significant changes in cancer mortality in the USA over the last several decades, in the whole country and in particular states. However, no in depth analysis has been published so far, dealing with changes in mortality time trends in the state of Ohio. Since the state of Ohio belongs to the states of relatively high level of all-sites mortality in both males and females, it is of interest to analyze recent changes in mortality rates, as well as to compare them with the situation in the rest of the USA. The main aim of this study was to analyze, describe and interpret all-sites cancer mortality time trends in the population of the State of Ohio. METHODS: Cancer mortality data by age, sex, race and year for the period 1970-2001 were obtained from the Surveillance Research Program of the National Cancer Institute SEER*Stat software. A joinpoint regression methodology was used to provide estimated annual percentage changes (EAPCs) and to detect points in time where significant changes in the trends occurred. RESULTS: In both, males and females mortality rates were higher in blacks compared with whites. The difference was bigger in males (39.9%) than in women (23.3%). Mortality rates in Ohio are generally higher than average USA rates--an overall difference was 7.5% in men in 1997-2001, and 6.1% in women. All-sites mortality trends in Ohio and in the whole USA are similar. However, in general, mortality rates in Ohio remained elevated compared with the USA rates throughout the entire analyzed period. The exceptions are the rates in young and middle-aged African Americans. CONCLUSION: Although direction of time trends in Ohio are similar in Ohio and the whole US, Ohio still have cancer mortality rates higher than the US average. In addition, there is a significant discrepancy between white and black population of Ohio in all-sites mortality level, with disadvantage for Blacks. To diminish disparities in cancer mortality between African Americans and white inhabitants of Ohio efforts should be focused on increasing knowledge of black people regarding healthy lifestyle and behavioral risk factors, but also on diminishing socioeconomic differences, and last but not least, on better access to medical care.

Adult↗

PubMed2002

The long-term time trends of peptic ulcer and ulcerative colitis are interrelated.

OBJECTIVE: A birth-cohort phenomenon in the time trends of a disease indicates that exposure to relevant risk factors must have occurred during an early period of life. The aim of this study was to determine whether birth-cohort patterns are common features of ulcerative colitis, gastric ulcer, and duodenal ulcer in different countries. METHODS: The number of deaths from ulcerative colitis, gastric, and duodenal ulcer in England, Netherlands, Italy, Switzerland, United States, and Scotland were retrieved from the respective national statistics offices. The death rates from the six countries were plotted against the period of birth. Age-standardized cohort mortality ratios were calculated as a summary of the overall mortality associated with each consecutive birth-cohort. RESULTS: In all countries alike, mortality from ulcerative colitis, gastric, and duodenal ulcer increased among successive generations born during the 19th century and, after reaching a sharp peak around the turn of the 20th century, declined among generations born subsequently. The rise in mortality from gastric ulcer preceded a similar rise in mortality from duodenal ulcer by 10-20 yr, and the temporal changes of duodenal ulcer coincided with those of ulcerative colitis. CONCLUSIONS: The sudden rise of peptic ulcer disease during the 19th century and the 10-20-yr time lag between gastric and duodenal ulcer are difficult to explain based on changing infection rates with Helicobacterpylori alone. The similarity between the time trends of duodenal ulcer and ulcerative colitis suggests the influence of one or more shared risk factors.

Adult↗