Artikel
Skin Cancer Mortality in Germany before and after the Post-Communist Transition: Still higher Non-melanoma Rates in East than in West Germany
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Veröffentlicht: | 10. September 2008 |
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Background
Until now mortality trends of melanoma and non-melanoma skin cancer in Germany have been studied only in West Germany [Ref. 1], [Ref. 2]. We were interested in comparing mortality trends of melanoma and non-melanoma skin cancer in West and East Germany before and after the post-communist transition. By analyses of health care utilization data in West and East Germany we explored potential reasons for mortality differences between West and East Germany.
Methods
We analyzed mortality data of skin melanoma and non-melanoma skin cancer (NMSC) of West Germany and East Germany (1980-2005). We calculated sex-specific age-standardized mortality rates and standard errors (SE) using the World Standard Population. We calculated age-specific mortality rates (20-39, 40-59, 60-79, 80+ years).
Results
Age-standardized skin melanoma mortality rates tended to be lower in East Germany than West Germany before the reunification. After reunification rates became very similar. However, age-standardized mortality rates of non-melanoma skin cancer were continuously higher in East than West Germany. The crude mortality rates of the period 1996-2005 were 5,15 (SE 0,13) and 8,77 (SE 0,36) per million among West and East German men and 4,53 (SE 0,12) and 8,86 (SE 0,35) among West and East German women respectively. The mortality rate differences among East Germans and West Germans in 1996-2005 are mainly due to 2,34-fold and 2,24-fold higher mortality rates among men and women aged 80+ years respectively who live in East Germany. Mortality time trends of NMSC by Federal State showed decreasing trends with the exception of Baden-Württemberg and Niedersachsen, which showed increasing time trends. According to the German National Telephone Health Survey, the percentage of men (45+ years) in West and East Germany who ever underwent an examination for early cancer detection was 66,1% and 50,9% respectively. Among women, the corresponding percentages were 84,5% and 76,5% respectively. Percentages in West Germany were higher across all age groups studied among both men and women. Number of contacts with private practitioners per 100.000 AOK insured people in West and East Germany in 2005 were especially lower in the elderly East Germans aged 70 years and more (East Germany: men 167 per 100.000, women 165 per 100.000; West Germany: men 178 per 100.000, women 180 per 100.000).
Conclusions
Even 15 years after reunification of West and East Germany the mortality of non-melanoma skin cancer, a cancer of the elderly, is still higher in East than West Germany although incidence rates of squamous cell cancers of the skin are not higher in East Germany. Baden-Württemberg and Niedersachsen showed increasing NMSC mortality time trends whereas all other Federal States showed decreasing or constant time patterns. Skin cancer mortality data of the Federal State of Bremen are biased due to a death certificate coding errors (personal communication with Klaus Giersiepen). Differences in the participation in early cancer detection examinations in West and East Germany and less private practitioner contacts may explain our findings.